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Sleep and Our Health

Sleep and Our Health. Dr. Terri Prodoehl Health sciences James Madison university July 2009. Sleep Problems?. Do you or a loved one snore? How about sleepwalk? Sleep Eat? Trouble staying awake?. Outline. About sleep Patterns and Stages How much sleep do we need? Sleep Disorders

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Sleep and Our Health

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  1. Sleep and Our Health Dr. Terri Prodoehl Health sciences James Madison university July 2009

  2. Sleep Problems? Do you or a loved one snore? How about sleepwalk? Sleep Eat? Trouble staying awake?

  3. Outline • About sleep • 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. How do we know about sleep?

  6. 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

  7. How much sleep do we need? • Infants 16-20 • Toddlers 12-14 • Pre School 11-13 • School Age 10-11 • Teens 9.5-10 • Most adults need 7 ½ -8 hours to function well • About 10% require more or less sleep • Pregnant women need more sleep

  8. Sleep Patternshttp://www.healthination.com/affiliate/usnews/sleepingproblems_videos.html • 5 stages of sleep during a normal night • Stages 1-4 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 • 1-4 , then REM, restart back at stage 1 • One complete cycle takes about 90-110 minutes • First cycles have relatively short REM sleeps • REM sleep time increases in later cycles

  9. Stages • Stage 1 • 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 • Stage 4 • Almost exclusively Delta waves • Considered deep sleep

  10. REM SleepRapid 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

  11. 2006 Declared a public health problem byInstitutes of Medicine of the National Academies • An estimated 50% of Americans are sleep deprived • 30% average less than 6 hours per night • Estimated 70 million with insufficient sleep • 7 out of 10 have trouble sleeping • 40 million suffer from some long term disorder • 20 million experience occasional problems • 1/3 of Americans have symptoms of insomnia • The cumulative effects of sleep loss and sleep disorder represent an under recognized public health problem

  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 • Disorders Website, University of MD • http://www.umm.edu/sleep/adult_sleep_dis.htm • http://www.healthination.com/affiliate/usnews/sleepingproblems_videos.html • Video with overview of sleep disorders

  16. Common Disorders in Children • Dyssomnias-disturbance in the amount, timing or quality of sleep • Insomnia • Sleep apnea, 1-3% • Restless leg syndrome • Narcolepsy-rare • Periodic limb movement • Parasomnias-disorders with abnormal behavior or physiological events, interference with sleep stage transition • Arousal disorders • Night terrors,4-8 yr old • Sleep walking, 6-12 yr olds • Up to 40% sleep walk • Sleep wake transition • Sleep talking • Nightmares, 3-5% • Teeth grinding or bruxism • Bedwetting, 15%, boys, age 3+

  17. Obstructive Apnea in Children • Most common sleep disorder • Occurs in 1-3% of children • Most common in preschool children • Symptoms During sleep • Snoring • Restless sleep • Interruption of breathing • Chronic mouth breathing

  18. 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

  19. Signs of Sleep Deprivation • Needing an alarm clock to wake up • Falling asleep within 5 minutes of hitting the pillow • Well-rested people take 10-15 minutes • Napping easily • High number on the Epworth Sleepiness Scale

  20. High sleepiness number, not feeling rested, not able to sleep, snoring? You might need A Sleep study!! http://www.umm.edu/sleep/sleep_studies.htm

  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 50-100 billion

  23. Poor Functioning • Drowsy driving • 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. Sleep HygieneWhat 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

  29. 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 carbos and foods with tryptophan • Practice stimulus control (see next slide)

  30. 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 10-15 minutes • Get up, leave the bedroom • Read or watch something dull • Room and bed comfortable • Little clutter (Feng Shui the bedroom) http://fengshui.about.com/ • http://video.about.com/fengshui/Feng-Shui-Bedroom-Tips.htm • No pets on/in the bed • Temperature Cool • Lighting low, expose yourself to bright lights during day • Bed, sheets, PJ’s comfortable and not binding

  31. Links to resources http://yourtotalhealth.ivillage.com/sleep http://www.sleepeducation.com/index.aspx http://www.umm.edu/sleep/online_res.htm http://www.aasmnet.org/ http://www.aasmnet.org/Links.aspx http://www.nhlbi.nih.gov/about/ncsdr/index.htm

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