1. Jackie hoyle, RPGST Griffin Hospital Sleep wellness Center
Sleep and Our Health
Jackie hoyle, RPGST
Griffin Hospital
Sleep wellness Center

2. Sleep Problems?

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. 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

6. What is Sleep? Sleep is a state marked by lessoned consciousness, lessened movement of the skeletal muscles, and slowed-down metabolism.

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 4 stages of sleep during a normal night
Stages 1-3 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
1-3 , 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
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

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

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

13. 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

14. 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

15. Common Sleep Disorders
Snoring/Apnea
Insomnia 9-12%
Narcolepsy
Restless leg syndrome-5%
Over 80 different disorders

16. 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

17. 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

18. Cardiovascular Disease and Sleep-disordered Breathing
Insomnia
© 2003 ResMed Corp

19. 1/3 of Americans are affected by Insomnia 50% consider their insomnia serious 10% have been prescribed a medication for the insomnia

20. Transient – less than 2 weeks (excitement or stress) Intermittent – repetitive episodes of transient (personal/professional problems) Chronic – insomnia greater than 6 months (20 million Americans a year)

21. Consequences of sleep disorders

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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 20 minutes
Get up, leave the bedroom
Read something dull
Room and bed comfortable
Little clutter
Keep bedroom temperature Cool
Lighting low, expose yourself to bright lights during day
Bed, sheets, PJ’s comfortable and not binding

29. 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

30. 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 foods with tryptophan
Practice stimulus control (see next slide)

31. © 2003 ResMed Corp