Sleep and Our Health

DR. TERRI PRODOEHLHEALTH SCIENCES

JAMES MADISON UNIVERSITYJULY 2009

Sleep and Our Health

DO YOU OR A LOVED ONE SNORE?HOW ABOUT SLEEPWALK?

SLEEP EAT?TROUBLE STAYING AWAKE?

Sleep Problems?

Outline

About sleep Patterns and Stages How much sleep do we need?

Sleep Disorders Types Prevalence Symptoms Causes

Consequences of sleep disorders Accidents/Decreased functioning Health

Treatment of Disorders Sleep hygiene

True or False

1. Sleep is the time for the general body and brain to shut down and rest.

2. Getting one hour less sleep per night than needed will not affect daytime functioning.

3. The body can adjust quickly to changes in sleep schedules

4. We need less sleep as we get older.5. A “good nights sleep” can cure problems

with excessive daytime sleepiness.

How do we know about sleep?

About Sleep

We spend 1/3 of our lives asleepSleep is an active process

No organ or regulatory system “shuts down” Slight decrease in metabolic rate

Some brain activity increases during sleep Delta Waves Many parts of the brain are as active as awake periods At least 2 hours of dream state per night

Specific hormones increase during sleep Growth hormone Melatonin

Specific cues exist for regulation of sleep

How much sleep do we need?

Infants 16-20Toddlers 12-14Pre School 11-13School Age 10-11Teens 9.5-10

Most adults need 7 ½ -8 hours to function well About 10% require more or less sleep Pregnant women need more sleep

Sleep Patternshttp://www.healthination.com/affiliate/usnews/sleepingproblems_videos.html

5 stages of sleep during a normal nightStages 1-4 or non-REM and REM (rapid eye

movement) During non-REM sleep, many of the restorative functions of

sleep occur During REM sleep, memories and thoughts from the day are

processed

Stages progress cyclically 1-4 , then REM, restart back at stage 1

One complete cycle takes about 90-110 minutesFirst cycles have relatively short REM sleepsREM sleep time increases in later cycles

Stages

Stage 1 Light sleep, drift in and out, awaken easily Eyes move slowly, muscle activity slows May experience a sense of falling followed by sudden muscle

contractions Stage 2

Eye movement stops Brain waves are slower, occasional bursts of rapid waves

Stage 3 Extremely slow waves-Delta waves Interspersed with smaller faster waves Considered deep sleep

No eye or muscle movement, difficult to awaken Time when sleepwalking, bedwetting, or terrors occur

Stage 4 Almost exclusively Delta waves Considered deep sleep

REM SleepRapid Eye Movement Stage

Brain waves increase to the awake level

Most dreams occur during this stage If awoken in this stage, most people remember their dreams

Physical changes during REM Increase in H.R., B.P., and breathing rate Breathing more shallow and irregular Eyes jerk rapidly Limb muscles temporarily paralyzed Some loss of temperature regulation Men may experience erections

Most people have 3-5 intervals of REM each night Infants spend 50% of time in REM Adults spend nearly half of time in Stage 2

20% in REM, other 30% divided among other stages Progressively spend less time in REM as we age

2006 Declared a public health problem byInstitutes of Medicine of the National

Academies

An estimated 50% of Americans are sleep deprived 30% average less than 6 hours per night

Estimated 70 million with insufficient sleep7 out of 10 have trouble sleeping40 million suffer from some long term disorder20 million experience occasional problems1/3 of Americans have symptoms of insomnia

The cumulative effects of sleep loss and sleep disorder represent an under recognized public health problem

Children

2/3 of children have several sleep problems per week

25%-40% of children have sleep disorders

10-12% snore regularly

Contributors to Sleep Deprivation/Deficit

Not going to bed! Inadequate time in bed… Must be “productive” mentality Attitude that sleeping is sloth or not necessary We get 1 ½ hrs. less than others since 1910

Poor Sleep HygieneSleep Disorders

Contributors to Sleep Disorders

GeneticsAging

Menopause, hot flashes, hormone changes 1/3 of older adults have insomnia More nocturnal awakenings, more fitful sleep

Overweight 40% have sleep apnea

Diabetes ½ of people with sleep apnea have diabetes

Pain/Illness Arthritis, osteoporosis, dementias, heart disease, lung disease,

cancers digestive disorders

MedicationsStress

Common Sleep Disorders

Snoring/ApneaInsomnia 9-12%NarcolepsyRestless leg syndrome-5%Over 80 different disorders

Disorders Website, University of MD http://www.umm.edu/sleep/adult_sleep_dis.htm http://www.healthination.com/affiliate/usnews/sleepingproblems_videos.html

Video with overview of sleep disorders

Common Disorders in Children

Dyssomnias-disturbance in the amount, timing or quality of sleep Insomnia Sleep apnea, 1-3% Restless leg syndrome Narcolepsy-rare Periodic limb movement

Parasomnias-disorders with abnormal behavior or physiological events, interference with sleep stage transition Arousal disorders

Night terrors,4-8 yr old Sleep walking, 6-12 yr olds

Up to 40% sleep walk Sleep wake transition

Sleep talking Nightmares, 3-5% Teeth grinding or bruxism Bedwetting, 15%, boys, age

3+

Obstructive Apnea in Children

Most common sleep disorder

Occurs in 1-3% of children

Most common in preschool children

Symptoms During sleep Snoring Restless sleep Interruption of breathing Chronic mouth breathing

General Symptoms of a Sleep Problem

Performance decrease: academic, physical, etc. Behavioral difficulties Irritable Hyperactive Frequent illness Headaches, jaw pain, earaches Depression, anxiety Daytime sleepiness

Signs of Sleep Deprivation

Needing an alarm clock to wake upFalling asleep within 5 minutes of

hitting the pillow Well-rested people take 10-15 minutes

Napping easilyHigh number on the Epworth

Sleepiness Scale

YOU MIGHT NEED A SLEEP STUDY!!HTTP://WWW.UMM.EDU/SLEEP/SLEEP_STUDIES.HTM

High sleepiness number, not feeling rested, not able to sleep,

snoring?

Consequences of sleep disorders

In general

4 out of 10 adults sleepiness interfere with activities a few days each month

20% adults sleepiness interferes a few days per week or more

Direct cost of sleep related problems 16 billion dollars

Indirect cost 50-100 billion

Poor Functioning

Drowsy driving Sleep deprived, 2-4 times greater risk of an accident 100,000 auto accidents 71, 000 injuries 1,550 deaths 20% of all drivers have dozed at least once behind the

wheel One night of sleep deprivation is equal to legal

intoxication

Disasters Chernobyl, Three Mile Island, Challenger, Exxon Valdez Contributed to by errors in judgment from fatigue,

sleepiness

More mistakes!

Work Performance and accidents Contributes to job absenteeism, lost productivity Mistakes and work accidents increase

Medical errors- study with sleepy interns

36% more serious errors Of which 31% caused a fatality

28% more intercepted errors 57% more non-intercepted errors 21% more medication errors 5.6 times as many serious diagnostic errors

Health Consequences

Cardiovascular system-increase in heart disease Increase in blood pressure Increase risk for heart attacks, strokes, 5 or fewer hours have

45% greater risk

Endocrine Affects appetite regulating hormone Diabetes and impaired glucose tolerance

2.5 times more with 5 or less hours of sleep 1.7 times more with 6 or fewer hours of sleep

Obesity and weight management Increase in stress hormones Thyroid and growth hormones affected

Immune system-more susceptible to illness

Health Consequences Continued

Nervous system-memory and learning affected Balance is affected, more falls, 2 to 4.5 greater chance of

falling Increased risk of tremors, seizures Increase in pain, frequent headaches

Mental Health Decreased neurotransmitters affecting mood

More distress, irritability, depression , alcohol use, suicide Decreased quality of life

Early death Less than 6 hours of sleep or less per night-

15%-30% greater risk of dying, regardless of cause Protective factors of avoiding tobacco, alcohol, and unhealthy foods

lost with sleep deprivation

Treatment of Disorders

Good Sleep HygieneMedicationsPsychotherapy, stress managementRelaxation techniquesOSA treatment

Mouth appliance Surgery-tonsils and/or adenoids Weight reduction if obese CPAP-Continuous positive airway pressure

Sleep HygieneWhat contributes to good sleep?

Relaxing Routine Warm bath/shower Quiet activities Lower lights

Regular sleep schedule Go to bed and get up around the same time Limit naps

Limit stimulating behaviors before bedtime Limit caffeine after 2 pm Limit alcohol after dinner Limit large or spicy meals Limit vigorous exercise 4-6 hours before bed

Sleep Hygiene Continued

De-stress, learn relaxation techniques Physical and mental

Maintain a regular physical activity routine Physical activity helps with stress Fitness reportedly helps with sleep quality

Do not go to bed hungry or full Light snack of carbos and foods with tryptophan

Practice stimulus control (see next slide)

Stimulus Control

Bed for sleeping only, limit other activities (except sex!) Eating, reading, watching television, studying, work, hobbies

Go to bed when you are drowsy If you don’t fall asleep within 10-15 minutes

Get up, leave the bedroom Read or watch something dull

Room and bed comfortable Little clutter (Feng Shui the bedroom) http://fengshui.about.com/

• http://video.about.com/fengshui/Feng-Shui-Bedroom-Tips.htm No pets on/in the bed Temperature Cool Lighting low, expose yourself to bright lights during day Bed, sheets, PJ’s comfortable and not binding

http://www.umm.edu/sleep/online_res.htm

Links to resources

http://www.sleepeducation.com/index.aspx

http://www.aasmnet.org/

http://yourtotalhealth.ivillage.com/sleep

http://www.nhlbi.nih.gov/about/ncsdr/index.htm

http://www.aasmnet.org/Links.aspx