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

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

3. 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

4. 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.

5. How do we know about sleep?

6. 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

7. How much sleep do we need?
Infants
Toddlers
Pre School
School Age 10-11
Teens
Most adults need 7 ½ -8 hours to function well
About 10% require more or less sleep
Pregnant women need more sleep

8. 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 minutes
First cycles have relatively short REM sleeps
REM sleep time increases in later cycles

9. 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

10. 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

14. 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

16. Children 2/3 of children have several sleep problems per week
25%-40% of children have sleep disorders
10-12% snore regularly

17. 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

18. 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

20. Common Sleep Disorders
Snoring/Apnea
Insomnia 9-12%
Narcolepsy
Restless leg syndrome-5%
Over 80 different disorders
Disorders Website, University of MD
Video with overview of sleep disorders

21. 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

22. 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

23. 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

24. Signs of Sleep Deprivation
Needing an alarm clock to wake up
Falling asleep within 5 minutes of hitting the pillow
Well-rested people take minutes
Napping easily
High number on the Epworth Sleepiness Scale

25. High sleepiness number, not feeling rested, not able to sleep, snoring?
You might need
A Sleep study!!

26. Consequences of sleep disorders

27. 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 billion

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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)

35. 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 minutes
Get up, leave the bedroom
Read or watch something dull
Room and bed comfortable
Little clutter (Feng Shui the bedroom)
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

36. Links to resources