1. Sleep Disturbances and Weight Gain: Examining the Evidence Eileen Chasens, DSN, RN Assistant Professor November 19, 2009

3. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1998 1990 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% • BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss/

4. Obesity in Children Enlarged Tonsil & Adenoids

5. A Good Night’s Sleepis when you…

6. A Bad Night’s Sleep is when you…

7. What is sleep? • State in which the individual is • Unresponsive to the external environment • Is accompanied by stereotypical behavior • Reversible • Basic need

8. Mean Hours of Sleep in Adults 7 to 8 hours recommended National Sleep Foundation, 2001 “Sleep in America” Poll of adults

9. Earth’s rotation on its axis is the fundamental orbital mechanism that underlies endogenous circadian rhythms.

10. Light Circadian “Pacemaker”Regulates Timing of Sleep and Wakefulness • Output Rhythms • Physiology • Behavior Suprachiasmatic Nuclei (SCN)

11. Sleep/Wake Restorative ProcessBalances Sleep and Wakefulness Awake Load Borbely, A. (1982). Neurobiology, 1; 195-204)

12. Reticular Activation System

13. Sleep-Promoting System

14. Normal Sleep Architecture

15. Changes in Sleep Architecture Associated with Aging

16. Normal Changes in Sleep With Age

17. EEG while Awake

18. Awake Alpha waves (if eyes are closed) Eyes moving together High muscle tone EEG Sleep Stages

19. EEG Sleep Stages Stage 1 Theta waves (3-7cycles second) Rolling eye movements High muscle tone

20. EEG Sleep Stages Stage 2 Sleep spindles (12-14 cycles/second) & K complexes No distinctive eye movement Lower muscle tone

21. EEG Sleep Stages Stages 3 & 4 Delta (slow) waves Stage 3: delta < half of epoch Stage 4: delta >half of epoch No distinguishing eye movement Low muscle tone

22. EEG Sleep Stages REM sleep Fast waves Rapid eye movements(phasic REM) Absence of muscle tone

23. Assessment of Sleep • Direct observation • Asking about sleep • Diaries • Use of a Sleep Questionnaire • Actigraphy • Sleep study

24. Assessment: Ask your subjects“how’s your sleep?” • Check if any of the following apply: • Sleep less than 7 or more than 9 hours/night • Snore loudly • Stop breathing or gasp during sleep • Excessive daytime sleepiness or doze off • Difficulty 3 or more times a week with insomnia symptoms • Unpleasant feelings in legs when trying to sleep • Interruptions to sleep

25. Self-Report Measures • Sleep diary for bed time, wake time(s), • include daytime activities and meals/beverages

26. Instruments to Evaluate Sleep • Epworth Sleepiness Scale • Johns MW (1991) Sleep, 14 (6),540-545) • Pittsburgh Sleep Quality Index • Buysse DJ et al. (1989) Psychiatry Res, 28, 193-213 • Functional Outcomes of Sleep Questionaire • Weaver et al. (1997). Sleep:835-43 .

27. The Epworth Sleepiness Scale 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing

28. Pittsburgh Sleep Quality IndexBuysse DJ et al. (1989) Psychiatry Res, 28, 193-213 • 19 items • Generates 7 "component" scores • Sum of scores from 7 components yields one Global Score. • Global PSQI >5 score distinguishes good and poor sleepers • http://www.sleep.pitt.edu

29. Functional Outcomes of Sleep Questionnaire • 30-item questionnaire developed to evaluate areas sensitive to sleep disruption • 5 Factor Design: • activity level, vigilance, intimacy and sexual relationships, general productivity, and social outcome areas • Short FOSQ 10-items

30. Body Movement Monitors Wrist Actigraphy

31. Actigraphy Examples

33. Physiological Measures Polysomnography (PSG) Multiple Sleep Latency Test (MSLT)

34. What are the links between sleep and obesity?... inadequate sleep duration because of lifestyle factors or insomnia?? Obesity Insomnia Lifestyle Factors Sleep

35. INSUFFICENT SLEEP DURATION 2nd to Lifestyle Factors • Caffeine, alcohol and nicotine • Exercise, too close to bedtime • Excessive naps • Irregular sleep schedules • Too many demands of daily life!

36. What is it? Difficulty getting to sleep Difficulty staying asleep Awakening too early from sleep Hyper-vigilant at night/ Tired & fatigued during the day? INSOMNIA

37. Insomnia • Transient - less than 2 weeks • Chronic - continuing difficulty with sleep for at least 6 months • Etiology: • Medical • Psychiatric • Pharmacologic • Primary Sleep Disorder • Genetic • Tobacco / Alcohol

38. 33 32 31 30 6 7 8 9 Average Nightly Sleep (Hrs.) Short Sleep Duration & BMI In the Wisconsin Sleep Cohort Adjusted BMI(adj. for age, gender) (N=1,024) Taheri S, et al. PLoS Med. 2004

39. Hrs. Slept / Day (incl. Naps) Abundant data indicates that we live in a sleep-restricted society Ancillary study of the CARDIA Study (n=668; age: 38-50) Lauderdale DS, et al. Am. J. Epi. 2006

40. Percentage of adults with < 6 hrs sleep per night Guo, et al. (2002). American J. Clinical Nutrition: 76: 653-8.)

41. Potential mechanisms where sleep loss is associated with weight gain Taherei, S. et al. (2006). Archives in diseases in Children: 81 881-884)

42. 3h 48’ Sleep 9h 03’ Sleep  CHO Breakfast Effects of Sleep Restriction (6 d) vs. Extension: Young, Healthy Men Glucose(mg/dl) Insulin(mlU/L) HOMA(Io x Go/22.5) (BMI: ~23) Spiegel K, et al. J. Clin. Endocr. Metab. 2004

43. After 2 days of 4hrs. sleep After 2 days of 10hrs. sleep Sleep Duration: Leptin, Ghrelin, Hunger and Appetite in Healthy Young Men Spiegel K, et. al. Ann. Int. Med. 2004

44. What are the links between sleep and obesity?... sleep fragmentation 2o to Circadian Rhythm Disturbances Type 2 Diabetes Circadian Rhythm Disturbances Insomnia Lifestyle Factors Sleep

45. Shift Work Sleep Disorder • Sleep disorder that affects people who frequently rotate shifts or work at night • The most common symptoms of SWSD are insomnia and excessive sleepiness. • Other symptoms of SWSD include: • Difficulty concentrating • Headaches • Lack of energy

46. What are the consequences of SWSD? • Increased accidents • Increased work-related errors • Increased sick leave • Increased irritability, mood problems, etc. • WEIGHT GAIN!

47. Work-shift period and Weight Gain (Geliebter, A. (2000). Nutrition ) Survey about weight gain since starting shift work 85 Respondents, 36 on Days, 49 on Late shift

48. A longitudinal study on the effect of shift work on weight gain in male Japanese workers.Suwazono Y. (2008) Obesity: 18877-1893.

49. What are the links between sleep and type 2 diabetes?... sleep fragmentation 2o to Restless Leg Syndrome Type 2 Diabetes Restless Leg Syndrome Circadian Rhythm Disturbances Insomnia Lifestyle Factors Sleep

50. Restless Legs Syndrome & Sleep Fragmentation Unpleasant, creeping feeling in legs Irresistible urge to move Associated with other medical conditions Periodic Leg Movements during sleep require evaluation