Sleep: The Golden Chain That Ties Health and Our Bodies Together (A Review of Sleep Disorders) Academy Of Medicine Clinical Day, February 24, 2012 Elliott K. Lee MD, FRCP(C), D. ABPN, D. ABPN Addiction Psychiatry, D. ABSM Assistant Professor, University of Ottawa Faculty of Medicine Sleep Specialist, Royal Ottawa Mental Health Center Sleep Disorders Clinic
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Sleep: The Golden Chain That Ties Health and Our Bodies Together (A Review of Sleep Disorders) Academy Of Medicine Clinical Day, February 24, 2012 Elliott.
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Sleep:The Golden Chain That Ties
Health and Our Bodies Together(A Review of Sleep Disorders)
Academy Of Medicine Clinical Day, February 24, 2012Elliott K. Lee MD, FRCP(C), D. ABPN, D. ABPN Addiction Psychiatry, D. ABSM
Assistant Professor, University of Ottawa Faculty of MedicineSleep Specialist, Royal Ottawa Mental Health Center Sleep
Disorders Clinic
Objectives
Describe the importance of sleep and impact of sleep disorders in the community.
Understand common sleep disorders and how they can be assessed and treated.
Outline
Review sleep architecture, and how sleep is controlled.
Review insomnia and excessive daytime sleepiness, and their causes
SLEEP
NREM Sleep
Stage N1, N2 (“Light sleep”)
procedural memory (skills, motor learning)
Stage N3 Deep or “Slow Wave
Sleep” (SWS)
CNS restorationDeclarative memory
REM Sleep
DreamingMood Regulatory Role?
Memory?
Sleep Hypnogram
Insomnia Excessive Daytime Sleepiness
Insomnia
Affects 3.3 million Canadians (1/7) according to Statistics Canada (2002)
Especially:- Middle aged (45-64)- Widowed- Minimal education- Obese- Women > men
Treating Insomnia:Personal Sleep Hygiene
Maintain a regular wake/sleep schedule, possibly add mild sleep restriction.
Refrain from taking naps. Exercise - but not within 3 hours of bedtime. Establish a relaxing routine before bedtime. Use the bedroom only for sleep activities. Avoid clock watching Set environment (light, noise, temperature)
at comfortable levels. Avoid caffeine after mid-afternoon.
Peppard PE et al. N Eng J Med, 2000; 342(19): 1378-84
Odds Ratio – AHI to Hypertension
Peppard PE et al. N Eng J Med, 2000; 342(19): 1378-84
Change in BP with use of CPAP (9 weeks)
Becker HF et al. Circulation, 2003; 107(1):68-73
Traditional View
Obesity
Insulin Resistance
Low Grade Inflammation
↑ Oxidative Stress
Endothelial Dysfunction
Hypertension
Ischemic heart diseases
Arrhythmias
CV stroke/TIA
CardiovascularDisease
Atherosclerosis and Hypoxemia?Savransky and colleagues studied mice
– divided into 4 groups:
Intermittent Air (Control)
10
10
Chronic Intermittent Hypoxemia
10
10
Regular diet
High Cholesterol
diet
*Savransky V et al Am J Respir Crit Care Med, 2007
Atherosclerosis and Hypoxemia?Which ones developed atherosclerosis?
Intermittent Air (Control)
Chronic Intermittent Hypoxemia
Regular diet
High Cholesterol
diet
0
0
0
9
*Savransky V et al Am J Respir Crit Care Med, 2007
Atherosclerosis and Hypoxemia?Sections of aorta from the mice:
Intermittent Air (Control)
Chronic Intermittent Hypoxemia
Regular diet
High Cholesterol
diet
*Savransky V et al Am J Respir Crit Care Med, 2007
Modern View (?)
Obesity
Insulin Resistance
Low Grade Inflammation
↑ Oxidative Stress
Endothelial Dysfunction
Hypertension
Ischemic heart diseases
Arrhythmias
CV stroke/TIA
CardiovascularDisease
Mechanical upper airway obstruction
↑ Oxidative Stress
↑ Sympathetic Activity
Insulin Resistance
Intermittent Hypoxemia
Low grade Inflammation
Independent additive risk factor
OSA
MonthsMarin JM et al. Lancet, 2005
Fatal CV events and OSA
Nonfatal CV events and OSAMarin JM et al. Lancet, 2005
Sleep and Mental Illness
OSA can exacerbate mental illness:- Aggression /cognition in schizophrenia- Depression- Nightmares in PTSD- Cognitive dysfunction in dementias- Relapse to substance abuse
Sleep Psychiatricillness
Lee EK and Douglass AB. Can J Psychiatry, 2010; 55(7): 403-12
CATAPLEXY:– Antidepressants – e.g. venlafaxine– Sodium oxybate (Xyrem)
Summary
Sleep has a distinct architecture and is normally regulated by a complex set of environmental, biological and social influences
Insomnia and excessive daytime sleepiness are common issues among patients
If sleep is problematic, assessment for an underlying sleep disorder such as obstructive sleep apnea, restless legs syndrome, narcolepsy or others is important, as effective treatments are available for these conditions
Screening Questions For Symptoms Of Poor Sleep
Do you feel satisfied with the quality of your sleep?
Does you partner complain about your sleep?
Do you have difficulties falling or staying asleep?
Do you have problems with sleepiness during the day?