Wellness: Prioritize Sleep · Sleep & Weight Loss ... • Program your body to happily anticipate going to bed ... Lose weight 10. Reduce your risk of heart attack and stroke. Nap

Wellness: Prioritize Sleep

(Nutrition, Exercise, Community)

Paul Nystrom, MDHennepin County Medical Center Department of Emergency Medicine

Assistant Chief Medical Director, Hennepin EMSMedical Director, Edina Fire & Police

Medical Director & Officer, Plymouth Police

No/Poor Sleep…

• …is a problem.

• The standard advice is to get more.

• But our culture doesn’t actually prioritize it.

Kirk Parsley, MD (TEDx)

• We pride ourselves on sleep deprivation

• We think we are immune

• We know performance suffers

Less Sleep & Health

1. Higher rates of heart disease, hypertension, dementia

2. Higher rates of sexual dysfunction

3. Higher rates of infection, allergy & asthma

4. Higher rates of depression, anxiety, anger, irritability, suicide

Less Sleep & Health

Virtually every body system or function is improved by sleep and detrimentally

affected by lack of sleep.

Evolution and Sleep

• Sleep would not appear to beneficial

• Necessities: food, water, avoiding predators and procreation

• The fact that sleep exists is a testament to how crucial it is

• It is only recently we have tried to ignore it

Sleep & Dementia

• Poor sleep may actually cause Alzheimer's Disease

• Glymphatic cells shrink during sleep and allow CSF to flush metabolic debris

• Purges the tau and beta amyloid proteins from the brain

Sleep & Heart Disease

• Poor sleep tips the sympathetic/parasympathetic balance to fight/flight

• More cortisol & adrenaline

• Less growth hormone

• Heart attacks and day light savings

• Increased in the spring (less sleep)

• Decreased in the fall (more sleep)

Sleep & Mental Illness

• Sleep is emotional first aid

• Lack of REM sleep contributes to mental illness

• Lack of REM sleep in adolescents is strongly associated with suicide

Dark Times

Death by Suicide-The EMS Profession Compared to the General PublicPrehosp Emerg Care. 2019 May-Jun;23(3): 340-32435.

CONCLUSION:In this statewide analysis, we found that EMTs had a significantly higher Mortality Odds Ratio due to suicide compared to non-EMTs. (5.2% vs 2.2%) (p = 0.0001)

Dark Times

• Police Executive Research Forum publication Oct 2019

• 9 suicides at NYPD in 2019

• 2 suicides in the Metro Nov 2019

Sleep & Diabetes

• Small studies restricting sleep:

• 4,5,6, hours/night for 1 week

• Insulin & blood sugar at pre-diabetic & diabetic levels

Sleep & Weight Loss

• No/poor sleep inhibits weight loss

• Muscle is preferentially lost instead of fat

Insulin Resistance OUR UNIFIED FIELD THEORY

Copyright 2002-2016. SpecialtyHealth, Inc. All rights reserved. Reproduction forbidden without permission.

Hunger Hormones

• Ghrelin- promotes hunger

• Increased with lack of sleep

• Leptin- inhibits hunger

• Reduced with lack of sleep

Growth Hormone (GH)

• The Repair hormone

• Released in response to:

• Deep sleep (slow wave sleep)

• High intensity exercise

• Fasting

Pilots have work hour restrictions.

Truckers have work hour restrictions.

ATCs have work hour restrictions.

Medical residents have work hour restrictions.

Public Safety has work hour restrictions.

Sleep Deprivation

• 18 hrs awake = performance at 0.05 BAL

• 24 hrs awake = performance at 0.08-0.1 BAL

Sleepy Driving• NTSB

• 100,000 highway crashes per year

• 71,000 injuries, 1500 deaths

• 20% of drivers report falling asleep behind the wheel

• NHTSA

• 1.2 million crashes per year

• 8000 deaths

Microsleep & Driving

• Falling asleep for seconds

• Drowsy driving causes more accidents than impaired driving

• Accidents are more lethal

Why do we Sleep?

Sleep Pressure & Circadian Rhythm

\

Sleep Cycles

• 5 stages

• 1,2,3,4

• REM- Rapid Eye Movement

• Repeating pattern in 90 min cycles

• 1,2,3,4,2,REM,2,3,4,2,REM,2,3,4,2,REM…

EEG Waves

Sleep Cycles

• Stage 1: occurs only once, a transition time

• Stage 2: >50% of sleep time, lighter sleep

• Stages 3 & 4: SWS, deeper sleep

• REM: 20% of sleep time

Stage 1

• Lasts 2-5 mins

• Least understood

• Quasi-REM

• “Hypnagogic state”

• Enlightening and inspirational

• Conscious and unconscious meld

Stage 2

• HR slows, body temp drops, unconsciousness

• Lighter sleep

• Important to prep your mind for learning

• Awaken relatively easily

Stages 3 & 4

• Slow Wave Sleep (SWS)

• Important to save memories

• Cortisol turns off, GH turns on

• Physical repairs

• Harder to wake up

REM

• Irregular, faster breathing, HR & BP rise

• Vivid dreams with paralysis

• Important for memory

• Mastering complex things

• Creativity

Caffeine Effects

• Blocks adenosine receptors in the brain

• Adenosine is usually inhibitory (downer)

• Fatigue/sleep pressure builds due to adenosine

Caffeine = Tool

• Good: Proven performance enhancer but effects are negated by tolerance.

• Bad: Long half life impairs sleep

• Make it a reliable tool

• Changing shifts

Energy Drinks

• The Up Sides…

Energy Drinks

• The Down Sides:

• Unknown ingredients

• Sugar

• Artificial sweeteners

• Caffeine tolerance

Use the Light

• Most powerful environmental/circadian cue

• Use light to your advantage

• Bright light early in your wake cycle

• Non-blue light before bed

• f.lux, Dark Mode, orange glasses

• Dashboard lights/work lighting

Sleep Hygiene• Consistent routine

• Sleep alarm

• Dark

• Sleep mask

• Cold

• 65 +/- degrees optimal

• Quiet

• Ear plugs or white noise

Sex & Snoring

• Your bed is for sleep or sex

• Program your body to happily anticipate going to bed

• Change your environment- sleep divorce?

• Get a sleep study if you snore

Emotional Commotion

• Guard your relationships

• Don’t check email before bed

• Prep your morning

• Keep a note pad by the bed

The Night Cap

• To relax…

• Messes with body cooling, HR, HRV

• Diuretic (waking up to pee)

Less Emotional Commotion

• Gratitude

• Practice awe

• Meditation/mindfulness

• Routines

• Tetris

Internal and External Wind Down

• External- cool down

• Decreased light

• Clock = Anxiety

• Eat & Exercise- >2-3 hrs before bed

Internal and External Wind Down

• Internal- meditation

• Journal “dump” with gratitude

• 50% less time to sleep

• Social Media & Email = Anxiety

• “Wired & Tired”

Anxiety disrupts Sleep

• Ephesians 4:26:

• “In your anger do not sin: Do not let the sun go down while you are still angry.”

• Maybe this is to protect your awake time, your relationships…

• …AND your sleep time.

Measure It

• When you don’t sleep well, figure out why

• Pay attention to your habits and activities

• Eating, sleep environment working out, alcohol, caffeine, screen time, etc.

Sleep Drugs

• All sleep drugs disrupt sleep architecture

• The best treatments for insomnia are behavioral

Insomnia is more often a Priority problem than a Physiologic problem

Treatment Priorities

1. Hygiene

2. Cognitive Behavioral Therapy for Insomnia (CBT-I)

Melatonin

• Questions:

• Timing

• Dose

• Dependence

• My take away: a reasonable option

To Nap or Not To Nap?

• Evolutionary evidence supports biphasic sleeping

• A longer period at night, shorter period 12 hrs later

• Lost with the invention of the clock and the industrial revolution

Nap Benefits1. Increase your alertness

2. Speed up your motor performance

3. Improve your accuracy

4. Make better decisions

5. Improve your perception

6. Fatten your bottom line

7. Preserve your youthful looks

8. Improve your sex life

9. Lose weight

10. Reduce your risk of heart attack and stroke

Nap Benefits1. Reduce your risk of diabetes

2. Improve your stamina

3. Elevate your mood

4. Boost your creativity

5. Reduce stress

6. Help your memory

7. Reduce your dependence on drugs/alcohol

8. Alleviate migraines, ulcers & other problems with psychological components

9. Improve the ease and quality of your nocturnal sleep

10. It feels good

The 20 min Power Nap

• Stage 1: 2-5 mins

• Stage 2: the first Stage 2 takes 17 mins at minimum

• Increases alertness

• Avoids SWS and sleep inertia

Naps & Nocturnal Sleep

• Naps do not adversely effect nocturnal sleep if:

1. You have normal sleep

2. Shorter than 3 hours (max 2 sleep cycles)

3. Wake up >3 hours before bedtime

Sleep Inertia

• Waking from SWS

• You are not “more tired” than before

• Proven solutions:

1. Physical activity

2. Sensory stimulation

3. Caffeine

Force Science News #323

“Restorative Rest”

• Henderson, Nevada

• Approved naps on dog watch

• In place of 60 minute meal

• Duty belt off, otherwise ready

• Radio on, alarm set

Napping on Shift

• Provide a nap room

• Dark & quiet

• Safe, secure location

• Make it specific

• i.e. Officers aren’t napping anytime/anyplace

Wasting Sleep Time

• Social media & FOMO

• Binge watching

• Screens & Technology are not our friends

Guard Your Sleep

• And your family & friends’ sleep

• Don’t call/text/message late except emergencies

• Change your phone settings

• Email, paging apps, Slack, social media…

• Use “Do Not Disturb”

Get out of Bed

• When you can’t sleep >20 mins

• Do something relaxing

• Never hit “snooze”

• Mental failure to start the day

• Loss of sleep and productive time

Closing Thoughts

• Sleep is absolutely a pillar of health

• The Swiss Army knife of health

• Prioritize & protect your sleep

Resources:

• Why We Sleep- Matthew Walker• Take a Nap, Change Your Life- Sara Medick• The Sleep Revolution- Arianna Huffington• Tools of Titans- Tim Ferriss •https://peterattiamd.com/matthewwalker1/• Kirk Parlsey- TEDx Reno

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