ERAMUS + The role of sleep in wellbeing

European Commission Office in Wales, Friday 2nd December

WHO AM I?• Graduated 2014 – Biochemistry with Study in Industry (BSc)

• Currently in the 3rd year of my Medical Research Council sponsored PhD studentship

• My PhD aims to ‘investigation sleep disturbances in children and adolescents with 22q11.2 deletion syndrome.’

22Q11.2 DELETION SYNDROME AND SLEEP

• Sleep in children with 22q11.2 deletion syndrome relate to their mental health

• 25-30 X increased risk for schizophrenia; ~40% ADHD; ~35% autism; ~32% anxiety

• Around 67% of them will report at least one sleep problem in their lifetime

• How does sleep relate to the mental health outcome?

HOW MUCH DO YOU KNOW ABOUT SLEEPINESS!?

• On Wednesday, this was featured on BBC News. • That’s how important sleep is!

• Let’s take a quick quiz!

• Don’t worry – I scored very poorly on it!!

WHAT IS SLEEP?• A naturally recurring state involving both body and ‘mind’ • Reduced consciousness • No response to things happening around you

• Closed eyes • Reduced movement• Lying down position • Slower breathing• Changing heart beat• Change in blood sugar

WHAT IS SLEEP?• Two very important parts of sleep:

• Homeostatic drive (meaning ‘staying the same’)

• Circadian drive (meaning ‘around a day’)

• Your brain controls this – master clock

• Light keeps your sleep/wake cycle going

• Non-Rapid Eye Movement Sleep• Rapid Eye Movement Sleep

STAGE 1 NREM SLEEP• This is your very light sleep – the

lightest!

• It is the first stage you go into after you close your eyes

• Someone could come and wake you up and it is the time where you will pretend you weren’t sleeping!

• It happens before deeper sleep

• Activity in your brain slowing down

STAGE 2 NREM SLEEP• This is where we can look at learning

• Add knowledge

• If someone has learnt something new that day

• Important for learning and memory

• Body moving about

STAGE 3 NREM SLEEP• This is the deepest sleep

• Where memories are remembered

• Deep sleep helps you to remember what you need to the next day, and forget the rubbish!

• Your body is able to move about

• Eyes aren’t really moving much

• Your brain is still working really hard – just slower!

REM SLEEP • This is a stage a bit like being between sleep

and awake

• This is when you dream

• You know just before you wake up, you have really vivid dreams – REM!

• Your eyes are moving about

• Your body won’t move

WHY DO WE SLEEP?• No one really knows!

1.Rest

2.Remove waste from the brain

3.Make memories

4.Survival technique!

IMPORTANCE OF SLEEP • Mental wellbeing – mental health problems, talking about emotions, expressing

emotions

• Physical wellbeing

• Social wellbeing – good relationships

• Weight maintenance

• Cognitive performance – do well at school

• Avoid accidents – road accidents, Chernobyl, Challenger

HOW MUCH SLEEP DO WE NEED?

http://sleephub.com.au/wp-content/uploads/2015/06/Screen-Shot-2015-06-21-at-7.53.47-am.png

• Changes over a lifetime

• We need to maintain the recommended amount

• Continuous sleep

• Issues at each point of life?

• Is there such thing as too much sleep?

CHILDREN• Very common for children to have nightmares, night terrors, sleep walk

• Around 8% of children under 10 experience nightmares• Up to 15% of children under 10 have experienced sleep walking

• Common problems • Beliefs about sleep – problems with bedroom environment • TV, films and tales about sleeping

• Parent routines

• Sleep isn’t exciting – apart from on Christmas Eve!

AMERICAN ASSOCIATION FOR SLEEP MEDICINE

This should be done on a regular basis to promote optimal health.

•Infants aged 4-12 months should sleep 12 to 16 hours per 24 hours (including naps)

•Children aged 1-2 should sleep 11 to 14 hours per 24 hours (including naps)

•Children aged 3-5 should sleep 10 to 13 hours per 24 hours (including naps)

•Children aged 6-12 should sleep 9 to 12 hours per 24 hours

•Teenagers aged 13-18 should sleep 8 to 10 hours per 24 hours

THE IMPORTANCE OF A GOOD NIGHT’S SLEEP FOR CHILDREN

• Children are growing – mentally, physically • Increased rates of mental health reports in children

• Neurological changes

• Physical changes

• School pressures

• Stress

SLEEP AND WELLBEING • We all know what we are like after a bad nights sleep

• We are more emotional• Our physical performance is poor • We can’t concentrate• Pay attention• Forming words and speaking is harder!

• How to keep fit and healthy? Don’t do the Gwyneth Paltrow diet – sleep!!!

WHAT ABOUT CHILDREN WITH BEHAVIOURAL PROBLEMS?

• Children with behavioural problems tend to have problems sleeping

• Children with autism or ADHD have more trouble getting to sleep and maintaining sleep

• They might wake up more during the night, or wake up especially early and stay awake

• What about being tired and daytime sleepiness?

YSGOL BRO EIRWG• Phone call from Rachel

• Mentioned Erasmus + and wellbeing focus

• Sleep questions in a main questionnaire

• What could I do for them?

YSGOL BRO EIRWG - QUESTIONNAIRE RESULTS

• Conducted 22nd-23rd October 2016

• KS2 – year 3-5, ages 7-11 years old

• Looked at wellbeing generally

• There were 4-dedicated questions surrounding sleep and circadian control

YSGOL BRO EIRWG - QUESTIONNAIRE RESULTS

• Conducted 22nd-23rd October 2016• KS2 – year 3-5, ages 7-11 years old

• 57% of respondents were female; 43% male

• 87.4% of respondents have access to a screen in their bedroom • 64.7% use this right up until sleep-time at night

• 45% go to bed after 9pm • 5.3% go to bed at or after 11pm

• Majority of pupils reported being tired at school

VISIT TO YSGOL BRO EIRWG• Discussion about sleep is and what we do

when we are sleeping

• Are you a lark, a hummingbird or an owl?

• Dream pillowcases

• Blue-light blocking glasses

WHAT TIME DO YOU SLEEP BEST?

• Chrono – to mean ‘time’ in greek

• ‘Time’-type – how much an individual to sleep/wake at a particular time dependent on their underlying 24-hour rhythms within a 24-hour day.

• Circadian timing

• Matching the environment

• Children different to adults?

YSGOL BRO EIRWG• Discussion about sleep is and what we do

when we are sleeping

• Are you a lark, a hummingbird or an owl?

• Dream pillowcases

• Blue-light blocking glasses

SLEEP DIARY• A sleep diary does what it says!

• Sleep and wake timings

• Duration of sleep during weekdays vs. duration of sleep at weekends

• Do 8-9 year olds have lie-ins?

MY SAMPLE GROUP • Sleep diaries given to ~60 children• Aged 8-9 years old• Year 2 at a Welsh primary school

• How many sleep diaries were returned?

• How many sleep diaries were completely filled in correctly?

EXAMPLE SHEET - COMPLETED

DATA • We had n = 24 complete responses which could be used • From this I could look at

• The time in bed• The time asleep• The time awake• The time out of bed

• Having these times I calculate:• The sleep duration (weekdays) - individual and average across all• The sleep duration (weekends) - individual and average across all

• I looked at sleep debt – was there recovery at the weekend?

DATA • There were n = 11 individuals that

slept longer during the week than they did at weekends

• There were n = 13 individuals that slept longer at weekends than during the week

• This is common for people to sleep longer at weekends to compensate for reduced sleep during the week.

• The difference is usually more marked in adults who usually accumulate a sleep debt.

DATA – WEEKEND VS. WEEKDAYS

• WEEKENDS• Average wake time – n =24 – 07:28• Average sleep onset time – n =24 –

09:21• Average sleep duration – n =24 – 10:06

• WEEKDAYS• Average wake time – n =24 – 06:48• Average sleep onset time – n =24 –

08:14• Average sleep duration – n =24 – 10:10

WHAT DID WE LEARN?• There is not much difference in wake time, sleep time or sleep duration

on average during the week vs. weekend in this group• They go to sleep later at weekends, and wake up later on average • Not much difference however

• There are individual differences

• This doesn’t model what teenagers do, and young adults mainly

• There is usually a sleep debt – this does suggest that these children are getting the right amount of sleep ON AVERAGE!

LIMITATIONS• Gender wasn’t accounted for

• Age wasn’t truly accounted for

• Socioeconomic background was taken into account

• Parental sleep behaviours and times were not collected

• Additional information is needed .i.e. use of blue-light technologies

NO MATTER THE AGE, HOW MUCH DEBT ARE YOU IN?

• Not where you’ve lost money, but loss of sleep!

• This is when the sleep duration is not enough

• You do not sleep enough during the week

• By the weekend or when you aren’t working, you sleep longer

• We say, “You are paying back your sleep debt!”

WHAT CAUSES SLEEP DEBT?• Busy lives/working late

• Families

• Mistreating sleep

• Drinking/eating late

• Anything that prevents you from getting your average amount of sleep

WHAT ARE THE SYMPTOMS OF SLEEP DEBT?

• Physical fatigue – lifelong diseases such as diabetes?

• Weight gain

• Mental fatigue – lack of emotion, lack of concentration, empathy, enthusiasm, mood swings

• Exhaustion

• Mental health problems

THE ROLE OF TECHNOLOGY • Technology measures

sleep

• Technology ruins sleep – especially in young adults, adolescents and children

• Control use of blue-light background technologies

BLUE LIGHT RESEARCH• Blue-light blockers do work…but not completely!

• They *reduce* the impact of the blue-light!

• Use red-filters

• You can get apps for phones and laptops/computers/tablets

• You can wear some snazzy glasses which can do the trick!

HOW DOES TECHNOLOGY IMPACT SLEEP/WAKE

• It delays getting to sleep

• It can cause fragmented and disturbed sleep

• In the mornings, looking at your phone straight away can disrupt the circadian rhythm

• This can lead to ill-health – mental and physical

EVEN TURNED-OFF TECHNOLOGY CAN IMPACT

SLEEP/WAKE

WHAT CAN BE DONE?• We need to look after our sleep,

promote sleep health

• Educate children about the problems with not getting enough sleep

• Sleep disorders are long-term problems • Mental health problems, diabetes,

cancer, eye problems

SETTING THE SCENE

What should my bedroom look like during the day?

What should be bedroom look like during the night?

SLEEP IS BEAUTIFUL!Creating a perfect sleep bedroom

https://sleepfoundation.org/bedroom/see.php

Paediatric sleep guidelineshttp://www.aasmnet.org/articles.aspx?id=6326

NHS – Better sleep

http://www.nhs.uk/LiveWell/sleep/Pages/sleep-home.aspx

Thanks for keeping your eyes open!

Any questions?