Dr. Terri Prodoehl Health sciences James Madison university July 2009 Sleep and Our Health Dr. Terri Prodoehl Health sciences James Madison university July 2009

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

Outline About sleep Sleep Disorders Consequences of sleep disorders 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 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.

How do we know about sleep?

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

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

Sleep Patterns http://www. healthination 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

Stages Stage 1 Stage 2 Stage 3 Stage 4 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

REM Sleep Rapid 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 by Institutes 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

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 Hygiene Sleep Disorders

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

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/sleepingproblems_videos.html Video with overview of sleep disorders

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

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 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

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

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 Disasters 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 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

Sleep Hygiene What 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

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