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Why does sleep matter?

Why does sleep matter?. Dr Neil Stanley Independent Sleep Expert. Myths in nocturia management. …and related sleep disturbance, are not important and do not need treatment’ …is a disease of the elderly male , and a natural part of the ageing process’

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Why does sleep matter?

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  1. Why does sleep matter? Dr Neil Stanley Independent Sleep Expert

  2. Myths in nocturia management …and related sleep disturbance, are not important and do not need treatment’ …is a disease of the elderly male, and a natural part of the ageing process’ …is only a symptom of some other underlying disorder, and is attributable to overactive bladder (OAB) in women, and benign prostatic obstruction (BPO) in men’ ‘Nocturia …

  3. The importance of sleep ‘ If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made 1 ’ 1. Rechtschaffen. The Control of Sleep. In: Hunt, editor. Human Behaviour and its Control. Cambridge, MA: Schenkman; 1971

  4. Function of sleep • Sleep remains a biological enigma, but is needed for recuperation and restoration of physical and mental functioning • It is important for optimal functioning of the endocrine, metabolic and immune systems • Affects all organs of the body • Sleep deprivation disrupts biological rhythms Hunter. EMBO reports 2008;9:1070–1073

  5. Different stages of sleep (1) Non-REM (NREM) sleep (75–80%) • Increasing sleep depth and decreasing muscle tone • Decreasing respiratory and heart rates, and decreasing eye movement • Physical rest and restoration of immune system • Stage 1: transition from awake to sleep (1–5%) • Stage 2: true sleep (45–50%) • Stage 3: • Stage 4: deep, slow-wave sleep (SWS: 25–27%) SWS characterised by slow breathing, low heart rate, low cerebral blood flow– deepest sleep REM, rapid eye movement

  6. Different stages of sleep (2) REM sleep (20–25%) • Irregular breathing and increased heart rate • Very low muscle tone • Vivid dreams • Psychological rest, emotional well-being and memory • 'Story-like' dream structure but forgotten unless waking occurs at this time

  7. Restorative sleep (SWS) occurs in first part of night Normal sleep hypnogram Stages Awake 1 REM REM REM REM REM 2 3 SWS 4 Hoursof sleep 1 0 2 3 4 5 6 7 8 SWS SWS, slow-wave sleep Stanley. Eur Urol Suppl 2005;3:17–23

  8. The time of awakening is important for daytime functioning • Awakening from REM sleep is most natural moment for arousal • Waking up during the first 3–4 hours of the night (slow-wave sleep) is more likely to leave a person groggy and tired during the following day than waking up later at night …and remember, every time a person awakes, it is probable that their partner is woken too… Stanley. Eur Urol Suppl 2005;3(6):17–23

  9. Lack of SWS has physiological consequences • There is a clear role for SWS in the maintenance of normal glucose homeostasis • This suggests that reduced sleep quality with low levels of SWS may contribute to an increased risk of type 2 diabetes Tasali et al. ProcNatlAcadSci USA 2008;105:1044–1049

  10. Sleep dysfunction: effects of daytime sleepiness Poor sleep associated with deficits in daily functioning:1,2 • Mood disturbance • Cognitive and memory impairment • Reduced performance at work Poor sleep associated with reduced health:1–4 ↑ Morbidity and mortality ↑ Risk of falling, traffic and occupational accidents ↑ Risk of cardiovascular disease and diabetes3 ↑ Risk of depression4 ↑ Healthcare costs ↓ Immune response 1. Carskadon. Med Clin North Am 2004;88:767–776; 2. Dinges et al. Sleep 1997;20:267–277 3. Newman et al. J Am Geriatr Soc2000;48:115–123; 4. Buysse. Geriatrics 2004;59:47–52

  11. Sleepiness leads to traffic accidents • Fatigue is thought to be involved in 16–60% of road accidents1,2 • Even moderate sleep deprivation is at least as dangerous whilst driving as low-level alcohol intoxication1,2 • The most vulnerable times for accidents are between 2 am and 7 am, and in the mid-afternoon3 1. Williamson & Feyer. Occup Environ Med2000;57:649–655; 2. Asplund. EurUrolSuppl2005;3:24–32; 3. Horne & Reyner. BMJ 1995;310:565–567

  12. But why are we discussing sleep at a urology congress?

  13. Nocturia is the leading cause of sleep disturbance in older adults How often do the following disturb your sleep? 90 n=1424; aged 55–84 80 Nocturia Headache Physical pain Money problems 70 Care-giving Family problems 60 Health concerns Uncomfortable bed Cough Prevalence (%) of self-reported causes of disturbed sleep 50 Night-time heartburn 40 30 20 10 0 Every Few Few Rarely Never night/almost nights/week nights/month every night National Sleep Foundation. Annual Sleep in America Poll (2003); Bliwiseet al. Sleep Med2009;10:7–8

  14. Nocturia makes people feel like they sleep badly • Respondents with nocturia: • Significantly more likely to define themselves as having insomnia (p<0.0001) • Significantly more likely to report low sleep quality (p<0.0001) • Nocturia is independent predictor of poor sleep regardless of gender and comorbid medical conditions Bliwise et al. Sleep Med 2009;10:7–8

  15. Nocturnal waking associated with sleepiness, naps and sick leave in general adult population Nocturnal awakening frequency/week * * * *p<0.001 vs awakening <3 nights/week * * * Proportion of patients * * * Daytime sleepiness Naps per week 76% of respondents reported need to go to the toilet as reason for awakening 43% of subjects with nocturnal awakenings reported having great difficulty resuming sleep once awakened Ohayon. J Psychiatr Res 2008;43:48–54

  16. Desmopressin prolongs the first period of sleep beyond the SWS Slow-wave sleep is disturbed in nocturia patients and desmopressin prolongs the first sleep period beyond the SWS1,2 1. van Kerrebroeck et al. EurUrol 2007;52:221–229 2. Diekelman & Born. Nat Rev Neurosci 2010;11(2):114–126

  17. Poor sleep predicts life dissatisfaction • Poor sleep predicts a consistent pattern of life dissatisfaction • Poor sleep may have direct impact on brain, emotions and mood Paunio et al. Am J Epidemiol 2009;169:206–213

  18. 43 Nocturia is associated with reduced QoL in patients with LUTS Percentage of patients with LUTS rating QoL as good or very good 90.6 42.9 Non-nocturics Nocturics Amongst LUTS patients, the proportion who rate QoL as good is more than halved if nocturiais present QoL, quality of life; LUTS, lower urinary tract symptoms Hernandez et al. Curr Med Res Opin 2008;24:1033–1038

  19. Conclusions: why does sleep matter? • Sleep is vital for: • Fragmented sleep can impair all of these • Nocturia is the major cause of fragmented sleep and therefore has many non-trivial consequences • Nocturia should be treated to bring meaningful benefits for the patient Health Alertness Well-being Essential biological/ physiological rhythms

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