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Kristen Knutson, PhDAssociate ProfessorCenter for Circadian & Sleep MedicineDepartment of Neurology
Sleep Health:what is it, why does it matter, & how do you get it?
Today, we will discuss:What is Sleep Health?•How much sleep people should get•Common sleep disorders
Why does it matter?•Consequences of poor sleep health
How do you get it?•Sleep health tips & resourcesQ&A
What is Sleep?
Sleep is divided into stages
• Rapid Eye Movement (REM)− Bursts of rapid eye movements− High brain activity− Lack of muscle tone
• Non-Rapid Eye Movement (NREM)− Stage 1 (“drowsy”)− Stage 2− Stage 3 (“deep sleep”)
EEG
EOG
EMG
REM = paradoxical sleep (active brain in dead body)
EEG, EOG & EMG in all stages
2nd half
1st half
Sleep cycles through stages throughout the night
Wake
REM
Wake
Stage 1
Stage 3
Stage 2Stage 2
Stage 3
Stage 2
Stage 1
Stage 2
REM
Amount of time in each stage is not equal
Spend most time in Stage 2
52%25%
15%
Sleep patterns and characteristics change over the life cycle.
Newborns/Infants More active in sleep; 50% REM; several periods of sleep; need naps
Toddlers Sleep begins to resemble adult patterns
Children Experience more deep sleep
Adolescents Shift to later sleep-wake cycle; experience daytime sleepiness
Adults Need regular sleep schedule to obtain sufficient, quality sleep
Older Adults More likely to have medical problems; sleep disrupters & disorders; sleep less efficiently
© Copyright 2003 National Sleep Foundation
Regulation of Sleep: 2 processes
Sleep regulation - balance between two processes.sleep
wak
e
9am 9am
Sleep
What is healthy sleep?• Amount of Sleep• Quality of Sleep
Recommendation for sleep latency (how long it takes to fall asleep)
≤30 minutes is appropriate but over 45 minutes is not.
Ohayon et al, Sleep Health: Journal of the National Sleep Foundation 2017 3, 6-19.
(65+ years)
Recommendation for number of awakenings (>5 min)
4 or more awakenings are inappropriate
Ohayon et al, Sleep Health: Journal of the National Sleep Foundation 2017 3, 6-19. (65+ years)
Recommendation for amount of time awake after having fallen asleep
For adults <65 years old, spending 20 minutes awake (or 30 minutes for 65+ year olds) is appropriate.
Ohayon et al, Sleep Health: Journal of the National Sleep Foundation 2017 3, 6-19.
(65+ years)
Sleep & Aging
Sleep changes as we age:- Sleep often becomes lighter- More awakenings- Get sleepy earlier in the day and wake up earlier- Sleep disorders become more common
This does not mean you mustput up with poor sleep!
Sleep Disorders
Sleep Disorders
Sleep Disorder Physician SpecialtySleep Apnea Sleep Medicine; PulmonologistInsomnia Sleep Medicine; Clinical
PsychiatristNarcolepsy Sleep Medicine; NeurologistRestless Legs Syndrome Sleep Medicine; NeurologistREM Sleep Behavior Disorder Sleep Medicine; NeurologistParasomnias (e.g. sleep walking)
Sleep Medicine
Obstructive Sleep Apnea
What is apnea?• Pauses in breathing due to blocked airway • Causes gasps and awakenings during sleepWho has apnea?• 18 million people• More often men• Those who are overweight • Those with high blood pressure Why is it bad?• Lowers oxygen levels in blood• Puts a strain on the heart• Associated with heart problems and daytime
sleepiness
© Copyright 2003 National Sleep Foundation
Treatment of Obstructive Sleep Apnea
Behavioral TherapyAvoid alcohol, nicotine and sleep medicationsLose weight if overweight
Physical or Mechanical TreatmentPAP (Positive Airway Pressure)Dental appliance
SurgeryUpper airway stimulation (UAS) via implant
© Copyright 2003 National Sleep Foundation
Insomnia
Symptoms:• Trouble falling asleep,• Trouble staying asleep, or• Waking too early and can
not go back to sleep• Problems with daytime function.
23
Prevalence of Insomnia• 30-40% of adults have experienced some level of insomnia• 10-15% of adults report chronic or severe insomnia
Mild or Transient
Severe or Chronic
Normal Sleep Pattern
Risk factors for insomnia
• Being Female− 50% more likely to develop insomnia than
men.• Older ages−Up to 64% of people over 65 years of age.
• Occupational:−Working outside traditional hours (e.g. 9-5)
• Lower socioeconomic status
Perpetuation of Insomnia – the 3 Ps
PREDISPOSING
PERPETUATINGPRECIPITATING
e.g. Hyperarousal
Illness, Medications, Alcohol, Stress, Shift work
Sedentary lifestyle, poor sleep hygiene, worry about sleep
Treatment of Insomnia
*Behavioral Management*Cognitive Behavioral TherapyRelaxation TrainingMindfulness Based Therapy
MedicationOver-the-Counter Prescription Medications
Speak with a doctor before taking any medication.
Narcolepsy
• Neurologic disorder characterized by a decreased ability to regulate sleep-wake cycles.
• Affects 1 in 2000 people• Symptoms: − excessive daytime sleepiness that leads to an irrepressible need to sleep− daytime lapses into sleep. − sudden muscle weakness when experiencing an intense emotion such as
laughter (cataplexy) − vivid dream-like hallucinations while falling asleep or when waking up − feeling completely paralyzed when waking up or falling asleep (sleep
paralysis).
Narcolepsy - Video
https://youtu.be/jTj3a2nHw8k
Video from PBS story about narcolepsy researcher at Stanford, Dr. Emmanuel Mignot.
Narcolepsy Treatments
Medications to treat:•Daytime Sleepiness (stimulants)
•Cataplexy
Scammell, Narcolepsy, New England Journal of Medicine (2015)
Recognizing Sleep Problems and Disorders
32
If you are concerned about your sleep, tell your doctor!
Why Does Sleep Health Matter?
Sleep: It does a body good
Sleep
Cognitive Function
Mental health
Brain UpkeepImmune
Function
Cardio-vascular Function
Metabolic Function
Endocrine Function
Accidents
Memory/Learning
Alzheimer's Disease
Diabetes
Obesity
AppetiteHypertension
Cardiovascular Disease
Infectious Disease
Cancer
Risk taking
Anxiety
Depression
Quality of Life
Effect of sleep loss on performance
• The longer they restrict sleep, the worse they get.
# of days
# M
ista
kes
0 hours in bed4 hours in bed6 hours in bed8 hours in bed
The less you sleep = the faster you deteriorate.
von Dongen et al, Sleep, 2003
What’s the relevance?
•How does impairment in performance, i.e. “lapses”, translate to the real world?Accidents!
Driving While Sleep Deprived = DUI
• Driving after being awake for 17 hours = driving with blood alcohol level of .05%.
• If you wake up at 7AM, this would = driving at midnight.
Dawson & Reid, Nature 1997Blood Alcohol Concentration
Perfo
rman
cePe
rform
ance
# of Hours Awake
I don’t need much sleep. I feel fine.
•No association between how a person felt after sleep deprivation & how they performed.
Leproult et al, AJP 2003
Effect of sleep on immune function• Effect of sleep restriction on response to flu shot.
• 25 healthy young men• Compared 4 nights of 4h in bed to 7.5-8.5 h
• Response to flu shot reduced by more than half.
Spiegel et al, JAMA 2002
0
0.5
1
1.5
2
2.5
Day 0 Day 10
Mea
n An
ti-In
fluen
za Ig
G Ti
ters
x 1
06 Antibody Response to Flu Vaccine
4h~8h
Effect of sleep on appetite
• Hormones that regulate appetite changed.• Increase in hormones that increase appetite.• Decrease in hormones that decrease appetite.
• Volunteers’ subjective feelings of hunger and appetite also increased.• Increased for all food types, but not all food types increased
equally.
Spiegel et al, JAMA 2002
Effect of sleep on appetite
Appetite for which food increased more?
OR
How do I improve my sleep?
Sleep Tips
Establish a regular sleep schedule.•Having a consistent bedtime helps your body prepare for sleep before you go to bed.
During the day:• Avoid caffeine− especially in late
afternoon/evening• Avoid alcohol− Especially right before
bedtime.• Avoid nicotine− Especially before bed.
Sleep Tips
Sleep Tips
Establish a sleep-friendly bedroom.
• Quiet− Electronics off; earplugs or white noise
• Dark− Eye mask, blackout curtains
• Cool but comfortable (~68°).• Reserve bed for sleep and sex
(no working!)
Sleep Tips
Avoid bright electronic devices before bedtime
• Takes longer to fall asleep • Reduces levels of the sleep-promoting
hormone melatonin • Reduces the amount and delays the
start of REM sleep • Reduces alertness the following
morning
Chang et al, PNAS 2014
Brochures
For more information:
• National Sleep Foundation: https://www.sleepfoundation.org/− They are dedicated to improving health and well-being
through sleep education and advocacy.• Project Sleep: https://project-sleep.com/− Mission: provide sleep disorder help, via raising awareness
about sleep health and sleep conditions.• Sleep education: http://sleepeducation.org/− This website has articles and information about sleep.