1. Melbourne Sleep Disorders Centre Sleep Dr David Cunnington, Sleep Physician MBBS MMedSc(Clin Epi) MAppMgt RPSGT RST FRACP FCCP FAASM Melbourne Sleep Disorders Centre

2. What does a sleep doctor do?

3. Melbourne Sleep Disorders Centre Look after people with sleep problems Can’t get to sleep or stay asleep Feeling tired all the time Sleep walking / talking / eating Working shift work Nightmares / bad dreams Snoring Restless legs

4. Melbourne Sleep Disorders Centre Monitor people while they are sleeping

5. Melbourne Sleep Disorders Centre Monitor people while they are sleeping

6. Melbourne Sleep Disorders Centre Teach people about good sleep

7. Melbourne Sleep Disorders Centre Conduct sleep research

8. Melbourne Sleep Disorders Centre Sleep Research What time do turn lights out? How long are you in bed before lights out? How long do you sleep for? How many times do you wake up? What time do you get up in the morning?

9. Melbourne Sleep Disorders Centre What time do turn lights out? 7:30-7:59 8:00-8:29 8:30-8:59 9:00-9:29 9:30-10:00 After 10:00

10. Melbourne Sleep Disorders Centre How long are you in bed before lights out? Less than 10 min 10-19min 20-29min More than 30 minutes

11. Melbourne Sleep Disorders Centre How long do you sleep for? Less than 8 hours 8 – 8 ½ hours 8 ½ - 9 hours 9 – 9 ½ hours 9 ½ - 10 hours 10 -10 ½ hours 10 ½ -11 hours More than 11 hours

12. Melbourne Sleep Disorders Centre How many times do you wake up? 0-1 2 3 4 5 6 More than 6

13. Melbourne Sleep Disorders Centre What time do you get up? 6:00-6:29 6:30-6:59 7:00-7:29 7:30-7:59 8:00-8:29 After 8:30

14. Melbourne Sleep Disorders Centre What is good sleep?

15. Melbourne Sleep Disorders Centre What is good sleep? Experience –Unaware of things around us Observer –Quiet, eyes closed, doesn’t respond Neurophysiological –Slowing of brain waves Functional –Have enough energy to do what we want to do

16. Melbourne Sleep Disorders Centre What is normal sleep?

17. Melbourne Sleep Disorders Centre Experience 7/10ths of the night (70%) –Unaware of things around us –Still 3/10ths of the night (30%) –Can hear things and be aware of things –Restless 10 hours of sleep 1-2 awakenings

18. Melbourne Sleep Disorders Centre Sleep changes as we get older Newborn: 15-16 hours Pre-school:14 hours Kindergarten:12 hours Primary School:10-11 hours High School:9 hours University:8 hours Parent:7.5 hours Grandparent:7 hours Great grandparent:6.5 hours

19. Melbourne Sleep Disorders Centre Kripke et al 2001 We all have different sleep needs

20. Melbourne Sleep Disorders Centre Time (hrs) Sleep Drive 168 Sleep debt

21. Melbourne Sleep Disorders Centre Time (hrs) Reduced sleep time – 1 night Sleep Drive 18 6 6 hours of ‘wake’

22. Melbourne Sleep Disorders Centre Time (hrs) Sleep Drive 18 6 6 66 16 24 36 Reduced sleep time – 4 nights

23. Melbourne Sleep Disorders Centre What happens when we don’t get enough sleep?

24. Melbourne Sleep Disorders Centre What happens when we don’t get enough sleep?

25. Melbourne Sleep Disorders Centre ‘The early bird gets the worm’

26. Melbourne Sleep Disorders Centre Most people feel tired on waking Jewett et al. (1999) It can take up to 2 hours to reach full alertness upon awakening. It can take even longer before we are functioning at our peak.

27. Melbourne Sleep Disorders Centre Delayed phase in teenagers 0600140022000600 14002200

28. Melbourne Sleep Disorders Centre Dreams Non-REM dreams –Things that are recent (in the last week or so) –Think about them over and over REM dreams –Strange things that we may not have put together before –Can be pleasant or scary

29. Melbourne Sleep Disorders Centre Stage 1 sleep (sleep wake) Drifting off to sleep –Can be aware of muscles relaxing Feels like falling –Can get muscle jerks or twitches –Still wake easily if someone talks to us –May not realise we have been asleep Usually lasts 5-10 minutes Each time we go in or out of sleep

30. Melbourne Sleep Disorders Centre Stage 2 sleep Asleep but –Can still have awareness of things around us –Have non-REM dreams –Can have restless movements Usually about half of the night

31. Melbourne Sleep Disorders Centre Stage 3 sleep (deep sleep) Deeply asleep –Unaware of things around us –If woken Not sure where we are Confused Can take a while to wake up More in the first few hours of the night

32. Melbourne Sleep Disorders Centre REM sleep (dreaming sleep) Deeply asleep –Unaware of things around us –Dreaming Sometimes can remember dreams after waking but unless write them down, can forget More towards the end of the night

33. Melbourne Sleep Disorders Centre Sleep stages Stage 4 Stage 3 Stage 2 Stage 1 REM Awake 24:0001:0002:0003:0004:0005:0006:0007:0008:00 Time (h) Non-REMREM

34. Melbourne Sleep Disorders Centre Good sleep habits

35. Melbourne Sleep Disorders Centre Bedroom Suitable for sleeping –Quiet –Dark –Temperature 15-20 degrees Bed –Laying flat –1 pillow best –Covering to regulate temperature

36. Melbourne Sleep Disorders Centre Good sleep habits?

37. Melbourne Sleep Disorders Centre Getting ready for sleep Have a routine –Preparing for bed at a regular time each day brush teeth / pyjamas on –In bed Read / relax Avoid over-stimulation –Excitement / light Familiar object / routine –Even adults have ‘teddies’

38. Melbourne Sleep Disorders Centre Good sleep habits?

39. Melbourne Sleep Disorders Centre Good sleep habits?

40. Melbourne Sleep Disorders Centre During night If wake up –Familiar object or routine Avoid trying to go to sleep –Aim to rest comfortably – sleep will come –Can distract yourself Imagine your favourite place Don’t do Sleep Maths –“It’s only 6 hours until my alarm goes and I’ve only had 2 hours sleep so I need to get back to sleep soon to get 8 hours of sleep”

41. Melbourne Sleep Disorders Centre In the morning Give the body signals that it’s time to wake up –Light –Movement –Noise

42. Melbourne Sleep Disorders Centre Sleep problems

43. Melbourne Sleep Disorders Centre Sleep walking / talking Almost all 5 year olds –Especially when more tired 2 in 100 adults (2%) Can be: –Talking / walking / eating / driving In children goes away as get older In adults, if causing problems, see doctor

44. Melbourne Sleep Disorders Centre Nightmares / night terrors Very common in early primary school children Can wake suddenly very scared In children goes away as get older In adults, if causing problems, see doctor

45. Melbourne Sleep Disorders Centre Snoring and sleep apnea 1 in 4 adults have loud snoring 1 in 20 adults stop breathing while sleeping If stop breathing can cause: –Feeling tired & grumpy –High blood pressure See a doctor to have a sleep test

46. Melbourne Sleep Disorders Centre Summary Getting enough sleep is important for our health We need to: –Have a suitable place for sleep –Maintain a regular bed-time and routine –Avoid over-stimulation before lights out –If we wake at night, don’t try to sleep or worry about sleep

47. Melbourne Sleep Disorders Centre Sleep Dr David Cunnington, Sleep Physician MBBS MMedSc(Clin Epi) MAppMgt RPSGT RST FRACP FCCP FAASM Melbourne Sleep Disorders Centre