2. Sleep Architecture REMRapid Eye Movement NREMNon-Rapid Eye Movement Stages 1 and 2 light sleep Stages 3 and 4 deep sleep 25% REM, 50% Stage 2 and 25% stages 3 and 4

4. Fatigue Effect of fatigue/sleep deprivation Increased irritability and lower stress tolerance Increased irritability and lower stress tolerance Low motivation (Cant be bothered) Low motivation (Cant be bothered) Faulty judgment Faulty judgment Lapses in attention and vigilance Lapses in attention and vigilance Impaired decision making and logical reasoning Impaired decision making and logical reasoning Increased risk taking Increased risk taking

5. Effect of fatigue/sleep deprivation Slowed reaction time Slowed reaction time Susceptibility to illness Susceptibility to illness Increased sensitivity to pain Increased sensitivity to pain All result in reduction in Performance & Safety All result in reduction in Performance & Safety

6. Three Most Common Sleep Disorders Are… 1)Insomnia 10 – 15% of adults suffer from chronic and severe insomnia 2) The Parasomnias 2) The Parasomnias Up to 10% of the adult population Up to 10% of the adult population 3) Snoring and Obstructive Sleep Apnoea (OSA) Snoring – up to 60% adults snore regularly OSA – 9% of males, 4% females over 40 3) Snoring and Obstructive Sleep Apnoea (OSA) Snoring – up to 60% adults snore regularly OSA – 9% of males, 4% females over 40

7. Insomnia Insomnia

8. Medical problems associated with Medical problems associated with Insomnia Insomnia Heart Disease x 2.27Heart Disease x 2.27 Cancer x 2.17Cancer x 2.17 Hypertension x 3.18Hypertension x 3.18 Diabetes x 1.8Diabetes x 1.8 Gastrointestinal x 3.33Gastrointestinal x 3.33

9. Sleep Hygiene To Provide information about lifestyle, and environment that might interfere with sleep, or promote better sleep. These strategies are important as a baseline, and should be combined with the other treatments. As a sole therapy, it is not effective for the more severe insomnia, but should be addressed in therapy.

10. Stimulus Control for those with insomnia Stimulus Control is based on classical Stimulus Control is based on classical conditioned response to certain stimuli. conditioned response to certain stimuli. This involves strengthening the relationship This involves strengthening the relationship between bed and sleep, between bed and sleep, and breaking the negative relationship and breaking the negative relationship between bed and anxiety and wakefulness between bed and anxiety and wakefulness Important and Effective Important and Effective

11. Bed Restriction Therapy for those with insomnia Sleep restriction therapy is designed to improve Sleep restriction therapy is designed to improve sleep consolidation and sleep efficiency. sleep consolidation and sleep efficiency. This is achieved by initially increasing the This is achieved by initially increasing the homeostatic drive to sleep. homeostatic drive to sleep. Sleep efficiency is improved. Sleep efficiency is improved. Time in bed can then be increased Time in bed can then be increased The most difficult, but the most effective The most difficult, but the most effective

12. The Parasomnias In Non-REM In Non-REM In REM In REM Sleep Related Movement Disorders Restless Leg Syndrome Restless Leg Syndrome Periodic Limb movements in Sleep Periodic Limb movements in Sleep The Parasomnias

13. In Non-REM In Non-REM Sleep Walking Sleep Walking Night terrors Night terrors Sleep Related Eating Disorder Sleep Related Eating Disorder Sexsomnia Sexsomnia REM related sleep disorders REM related sleep disorders Nightmare Nightmare REM-Sleep Behaviour Disorder REM-Sleep Behaviour Disorder

14. Sleep Related Movement Disorders: Restless Leg syndrome Essential features Essential features - Unpleasant sensation in the legs requiring the urge to move - Unpleasant sensation in the legs requiring the urge to move - Urge to move is worse at times of inactivity - Urge to move is worse at times of inactivity - Unpleasant sensation is partially or completely relieved by movement - Unpleasant sensation is partially or completely relieved by movement - Unpleasant sensation is worse in the evening or at night. - Unpleasant sensation is worse in the evening or at night.

15. Sleep Related Movement Disorders: Periodic Limb Movements in Sleep - Daytime sleepiness - Daytime sleepiness - Restlessness during sleep - Restlessness during sleep - Nighttime arousals - Nighttime arousals - Observed limb jerking at night. - Observed limb jerking at night. Typically extension of the big toe, Typically extension of the big toe, dorsiflexion of the ankle, dorsiflexion of the ankle, occasional flexions of the knee, and hip occasional flexions of the knee, and hip

16. The Agony or the Ecstasy The Agony or the Ecstasy Familiar?

17. Snoring Related Complaints Drives wife from bedroom Girlfriend wont marry me Shakes entire house Ask me to leave movies and church Has had to leave boat so friends could sleep Fall asleep at traffic lights waiting for red light to change

19. Consequences of Sleep Apnoea 1. Daytime fatigue, especially sleepiness 2. Bed partner sleep disturbance 3. Cardiovascular complications

20. Consequences of Sleep Apnoea Medical consequences :- Hypertension Insulin Resistance Cardiac Arrhythmia Heart Attack Stroke Nocturnal GORD Nocturia Depression

21. Risk Factors for Sleep Apnoea (Not exclusive) Male Increasing age Body Mass Index > 30 Neck Circumference > 42cm ( 17ins) Alcohol ( > 2 units) Smoking Post Menopausal Women Sleeping Pills

23. Laugh and the world laughs with you… …snore and you sleep alone.

24. Thank You Dr Alex Bartle SLEEP WELL CLINIC Christchurch, Auckland, Wellington Nelson, Tauranga, Whangarei www.sleepwellclinic.co.nz