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

2. What does a sleep doctor do?

3. 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. Monitor people while they are sleeping

5. Monitor people while they are sleeping

6. Teach people about good sleep

7. Conduct sleep research

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

11. 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. How many times do you wake up? 0-1 2 3 4 5 6 More than 6

13. 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. What is good sleep?

15. 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. What is normal sleep?

17. 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. 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. We all have different sleep needs Kripke et al 2001

20. Sleep debt Sleep Drive 16 8 Time (hrs)

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

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

23. What happens when we don’t get enough sleep?

24. What happens when we don’t get enough sleep?

25. ‘The early bird gets the worm’

26. Most people feel tired on waking • 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. Jewett et al. (1999)

27. 0600 1400 2200 0600 Delayed phase in teenagers 1400 2200

28. 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. 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. 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. 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. 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. REM Non-REM Awake REM Stage 1 Stage 2 Stage 3 Stage 4 24:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 Time (h) Sleep stages

34. Good sleep habits

35. Bedroom • Suitable for sleeping • Quiet • Dark • Temperature 15-20 degrees • Bed • Laying flat • 1 pillow best • Covering to regulate temperature

36. Good sleep habits?

37. 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. Good sleep habits?

39. Good sleep habits?

40. 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. In the morning • Give the body signals that it’s time to wake up • Light • Movement • Noise

42. Sleep problems

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