Dr' Terri Prodoehl

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Sleep and Our Health

• Dr. Terri Prodoehl
• Health sciences
• James Madison university
• July 2009

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Sleep Problems?

• Do you or a loved one snore?
• How about sleepwalk?
• Sleep Eat?
• Trouble staying awake?

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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

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True or False

• Sleep is the time for the general body and brain
  to shut down and rest.
• Getting one hour less sleep per night than needed
  will not affect daytime functioning.
• The body can adjust quickly to changes in sleep
  schedules
• We need less sleep as we get older.
• A good nights sleep can cure problems with
  excessive daytime sleepiness.

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How do we know about sleep?
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About Sleep

• We spend 1/3 of our lives asleep
• Sleep 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

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How much sleep do we need?

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

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Sleep Patternshttp//www.healthination.com/affili
ate/usnews/sleepingproblems_videos.html

• 5 stages of sleep during a normal night
• Stages 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 minutes
• First cycles have relatively short REM sleeps
• REM sleep time increases in later cycles

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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

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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

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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 sleep
• 7 out of 10 have trouble sleeping
• 40 million suffer from some long term disorder
• 20 million experience occasional problems
• 1/3 of Americans have symptoms of insomnia
• The cumulative effects of sleep loss and sleep
  disorder represent an under recognized public
  health problem

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Children

• 2/3 of children have several sleep problems per
  week
• 25-40 of children have sleep disorders
• 10-12 snore regularly

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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 Hygiene
• Sleep Disorders

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Contributors to Sleep Disorders

• Genetics
• Aging
• 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
• Medications
• Stress

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Common Sleep Disorders

• Snoring/Apnea
• Insomnia 9-12
• Narcolepsy
• Restless 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/slee
  pingproblems_videos.html
• Video with overview of sleep disorders

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Common Disorders in Children

• 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

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

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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

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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

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Signs of Sleep Deprivation

• Needing an alarm clock to wake up
• Falling asleep within 5 minutes of hitting the
  pillow
• Well-rested people take 10-15 minutes
• Napping easily
• High number on the Epworth Sleepiness Scale

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

• You might need
• A Sleep study!!
• http//www.umm.edu/sleep/sleep_studies.htm

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Consequences of sleep disorders
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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

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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

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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

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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

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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

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Treatment of Disorders

• Good Sleep Hygiene
• Medications
• Psychotherapy, stress management
• Relaxation techniques
• OSA treatment
• Mouth appliance
• Surgery-tonsils and/or adenoids
• Weight reduction if obese
• CPAP-Continuous positive airway pressure

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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

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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)

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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 dont 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, PJs comfortable and not binding

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Links to resources
http//yourtotalhealth.ivillage.com/sleep
http//www.sleepeducation.com/index.aspx
http//www.umm.edu/sleep/online_res.htm
http//www.aasmnet.org/
http//www.aasmnet.org/Links.aspx
http//www.nhlbi.nih.gov/about/ncsdr/index.htm
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