Dr. Colin M Shapiro MBBCh, PhD, MRC Psych. FRCP(C) Professor, Department of Psychiatry and Opthalmology University of Toronto Director, Sleep and Alertness.

Dr. Colin M ShapiroMBBCh, PhD, MRC Psych. FRCP(C)

Professor, Department of Psychiatry and Opthalmology

University of Toronto

Director, Sleep and Alertness Clinic

Youthdale Child & Adolescent Sleep Centre

Adam and Oswald: Clinical Science 1983, 65, 561

In nocturnal animals peak rates of RNA and protein synthesis, RNA and protein content of cells, number of cells and growth rates occur at the time when sleep predominates i.e., during the light period.

**Each star represents a published report

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Activity Period Sleeping Period

1800h 2400h 0600h 1200h 1800h

LIFE - Cycle and SleepComposition of SleepComposition of Sleep

16

14

12

10

8

6

4

2

REM

DEEP

LIGHT

Newborn16 hrs. avg.

Young Adult8 hrs. avg.

Adult7 hrs. avg.

Elderly6 hrs. avg.

50%

25%

24%

1%

26%

19%

53%

2%

18%5%

62%5%

WAKE

25%

11%

61%

3%

INSOMNIA Difficulty Falling asleep Can’t Stay asleep (keep waking up) Wake up too Early in the morning Sleep is not Refreshing

Can affect up to as many as 1 in 5 teens Signs: always Fatigued; Drinking too much Caffeine; Inattention; Irritable; Lack of Get-up and Go

Melatonin

• secreted by the pineal gland • melatonin is produced to help our bodies

regulate our sleep-wake cycles • Darkness stimulates the release of melatonin

and light suppresses its activity • melatonin cycles are disrupted when we are

exposed to excessive light in the evening or too little light during the daytime

• Difficulty with sleep onset at desired time• Once initiated, sleep is normal• Most common CRSD referral• Population data lacking

• Population estimates of prevalence of 0.17 – 0.25%• Prevalence increases to >15% amongst adolescents• Insomniacs: 10%• Positive family history

Sleepiness inSeattle & Toronto

You are here

Your body clock is in Vancouver

• Melatonin

• Bright Light Therapy

• Chronotherapy

++• Behavioural Strategies

19 21 Midnight 3 6 9 Noon

Normal Sleep Phase

DSPD

Phase ADVANCE

Melatonin “pulls” sleep time forward

Light “pushes” it away/forward

Sleep

Period

Sle

ep

P

eri

od

Chronotherapy

Light Application

• Lifestyle changes• Sleep hygiene

guidelines• Changing attitude

Rahman, Kayumov,Casper & Shapiro

• Patient with phase delay are more likely to develop depression!

• 2010

School-related Symptoms of Youth Depression

• Poor performance in school, truancy, tardiness• Withdrawal from school activities/peer groups• Lack of enthusiasm, energy or motivation• Globalized anger and rage• Overreaction to criticism, increased self-criticism• Indecision, lack of concentration or forgetfulness• Restlessness and agitation• Problems with authority• Suicidal thoughts or actions (e.g., cleaning out

locker, giving away items)

• Fear of failure• social rejection• bodily sickness• bullying or abuse• childhood memories• thoughts of a better life• separation with family• worries about the future

• This booklet was distributed to parents, school boards, family doctors, group practice and social workers .

• Response was positive and helped families in particular to accept the diagnosis and initiate treatment specifically.

• Parents and health professionals were able to recognize the behavior in the children after reading this booklet.

• This educational tool also helped in the early recognition, detection and assessment of depression in children and teenagers at the sleep clinic.

• Active investigation into markers of circadian phase in humans

• Two currently utilized markers• Core body temperature• Dim light melatonin onset (DLMO)

Mel

ato

nin

(p

g/m

l)

Time of Day

• Increase in levels begin between 6:00 pm & 9:30 pm (DLMO)

• Levels peak approximately 3:00 am & begin to decrease

• Lowest levels just before awakening

Mela

ton

in

pg

/ml

Time

Mela

ton

in

pg

/ml

Time

Mela

ton

in

pg

/ml

DSPD

Normal

Time

Mela

ton

in

pg

/ml

DSPD

Approx 5 hours

Mela

ton

in DLM

O

CT min

ap

prox

2hr

s bef

ore

habi

tual

wak

e tim

e

HABITUAL WAKE UP TIME (~11:00 a.m.)

• See also Ottawa slides on ADHD and Tourette’s Syndrome