Understanding Sleep Disorders for the Clinician Part 1

1. Understanding Sleep Disorders for the Clinician Part 1 Lisa Cottrell, Ph.D., CBSM, DBSM

3. Sleep in America, 2018 • According to the National Sleep Foundation 2018 “Sleep in America” poll: • 65% of American adults believe that sleep contributes to next day effectiveness • 10% prioritize it over other aspects of daily living • 35% prioritize fitness and nutrition • 27% prioritize work • 17% prioritize hobbies and interests • 9% prioritize social life

4. According to previous National Sleep foundation studies, sleep health is strongly connected in self report to overall health, stress levels and life satisfaction. Those studies further indicate that sleep health is a strong independent predictor that a person will feel effective in daily functions. So, why don’t more people make it a priority?

5. More Sleep in America poll results • 90% of Americans say their day starts when they get up, rather than with their sleep the night before • 60% generally don’t take into account how much sleep they’ll need the night before when planning their day Just so we know where we stand when we are addressing sleep concerns…

6. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society “Sleeping less than 7 hours per night on a regular basis is associated with adverse health outcomes, including weight gain and obesity, diabetes, hypertension, heart disease and stroke, depression and increased risk of death. Sleeping less than 7 hours per night is also associated with impaired immune function, increased pain, impaired performance, increased errors and greater risk of accidents.” (Watson, N.F. et. al., 2015)

8. Purpose of Sleep There is no unified theory about the function of sleep. It probably has more than one function: energy conservation, nervous system recuperation, memory consolidation, brain plasticity, emotion regulation, survival benefits by reducing risks associated with wakeful activity

10. Measurement of Sleep • Objective measurement using polysomnography • Sleep staging • Electroencephalography • Electro-oculography • Electromyography • Central nervous system arousals • Electroencephalography • Sleep-related breathing • Thermal sensor at nose and mouth • Nasal pressure transducer • Esophageal manometer/chest-abdominal inductance plethysmograph/intercostal electromyography to detect respiratory effort • Pulse oximetry • Cardiac rhythm • Electrocardiogram

14. Measurement of Sleep • Subjective assessment • Standardized sleep questionnaires • E.g., Pittsburgh Sleep Quality Index • E.g., Insomnia Severity Index • E.g., Epworth Sleepiness Scale • Sleep diary • Interview • Includes sleep history, assessment of symptoms of sleep disorders, medication and substance use patterns, medical history and exam, psychiatric assessment

15. Sleep and Psychological Health “Psychiatric disorders and sleep are related in important ways. In contrast to the longstanding view of this relationship which viewed sleep problems as symptoms of psychiatric disorders, there is growing experimental evidence that the relationship between psychiatric disorders and sleep is complex and includes bi-directional causation.” Krystal, A. D. (2012)

16. Sleep and Psychological Health “Healthy sleep is required for restoring functioning and vitality, promoting memory consolidation, and maintaining immune function. However, many individuals are affected with sleep disorders. There are about 60 million Americans who have problems with sleep, with associated costs of about $16 billion each year in medical care. Insomnia affects about 10% to 15% of the population, sleep apnea affects about 10%, followed by other sleep disorders, such as restless legs syndrome and circadian rhythm disorders. Untreated sleep disorders can increase the risk of heart disease, motor vehicle accidents, memory problems, depression, and impaired functioning” Khurshid, K. (2015)

17. This is the end of Part 1. Please continue to Part 2 in the next segment.