Sleep Presentation

Sleep Presentation

by Mendy Peterson PA-CApril 23rd 2009

Objectives:What is Normal Sleep? -circadian rhythm and EEG's -brain and hormones -sex and age patterns Common Sleep Disorders: -parasomnias and insomnia's -sleep apnea & obesity -sleep lab studies Consequences of Abnormal Sleep: -Health -Cost and Employers -Car Accidents -2007 Sleep in America Poll How to Change! -Day & Bedtime routines -Medications & Alternative Meds -Naps

What is Normal Sleep?

Cortisol is a hormone released by the adrenal gland that sits on top of the kidney.

That was

"Cortisol"

NOT

"Caffeine!"

Theta Waves

Sleep Spindles/K Complex

Delta Waves

More Delta Waves

Dreams!

Which is better- REM vs Non-REM?

Hormones and Sleep

TSH - ThyroidCortisol - Adrenal GlandsProlactin - Pituitary/Breast milkGrowth HormoneMelatoninSerotonin - Mood stabilizerEpinephrine - "I am speed!"Estrogen - ahhhh menopause! And..... Many Many more!

Men vs. Women

Hard Sleep Light Sleep

6 hours 8 hours +

Better Worse

More Less

More Less

More Less

How Hard? How Long?

With Mate?

Sleep Apnea? Sleep Disorders?Car Accidents

Sleep Questionnair

e

0 = Would never doze 1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = High chance of dozing Sitting and Reading _____Watching TV _____Sitting inactive in a public place (i.e. theatre) _____As a car passenger for an hour without a break _____Lying down to rest in the afternoon _____Sitting and talking to someone _____Sitting quietly after lunch without alcohol _____In a car, while stopping for a few minutes in traffic _____ A score of greater than 10 is a definite cause for concern as it indicates significant excessive daytime sleepiness. Consider completing full questionnaire and submit to your doctor!

Sleep Disorders

SHORTENED SLEEP LATENCY

Alcohol and drug induced sleepNarcolepsySleep apneaSleep deprivation

Prolonged Sleep Latency

Delayed sleep phase syndromeInadequate sleep hygienePsychiatric disorders-Acute schizophrenia, Major depression, and ManiaRestless leg syndrome

Causes of shortened or sleep onset REM sleep

Alcohol, sedative and hypnoticsDepressionNarcolepsySleep apneaSleep deprivation

Sleep disorders in aged

Leg movement disordersREM behavior disorderSleep apnea syndromeMedication induced sleep disordersMedical disorders especially cardiovascular disturbances and painDementiaNeurological disordersDepression

Dyssomnias-characteristics

Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these. Transient episodes are usually of little significance. Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors

Dyssomnias-causes

There are over 30 recognized kinds of Dyssomnias. Major groups of Dyssomnias include:Intrinsic sleep disorders - 12 disorders recognized, including

hypersomnia, narcolepsy, periodic limb movement disorder, restless legs syndrome, sleep apnea.

Extrinsic sleep disorders - 13 disorders recognized, including alcohol-dependent sleep disorder, food allergy insomnia, inadequate sleep routine.

Circadian rhythm sleep disorders - 6 disorders recognized, including advanced sleep phase syndrome, delayed sleep phase syndrome, jetlag, shift work sleep disorder

Dyssomnias-conditions-Narcolepsy

Narcolepsy is a neurological condition most characterized by Excessive Daytime Sleepiness (EDS). A narcoleptic will most likely experience disturbed nocturnal sleep, confused with insomnia, and disorder of REM or rapid eye movement sleep. The main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places Four other classic symptoms of narcolepsy, which may not occur in all patients, are cataplexy, sleep paralysis, hypnogogic hallucinations, and automatic behavior.

Periodic Limb Movements

Periodic Limb Movement Disorder (PLMD), also called nocturnal myoclonus, is a sleep disorder where the patient moves involuntarily during sleep It is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMD. However, most people with PLMD do not experience RLS Nocturnal myoclonus is treated by medications aimed at reducing or eliminating the leg jerks or the arousals. Non-ergot derived dopaminergic drugs (pramipexole and ropinirole) are preferred. Other dopaminergic agents such as co-careldopa, co-beneldopa, pergolide, or lisuride may also be us These medications are also successful for the treatment of RLS restless leg syndrome.

Restless Leg Syndrome-types

Primary RLS is considered idiopathic, or with no known cause. Secondary RLS often had a sudden onset and may be daily from the very beginningThe most commonly associated medical condition is iron deficiency (medicine), which accounts for just over 20% of all cases of RLS. The conditions include: pregnancy, varicose vein or venous reflux , folate deficiency, uremia, diabetes, thyroid problems, peripheral neuropathy, Parkinson's disease and certain auto-immune disorders such as Sjögren's syndrome, Celiac Disease, and rheumatoid arthritis. Treatment of the underlying condition often eliminates the RLS.

Parasomnias-what, why and which ?

A sleep disorder is a physical and psychological condition or disturbance of sleep and wakefulness caused by abnormalities that occur during sleep or by abnormalities of specific sleep mechanisms Although the sleep disorder exists during sleep, recognizable symptoms manifest themselves during the day Accurate diagnosis requires a polysomnogram, widely known as a "sleep test.“

Parasomnias-classifications

A. Arousal-Sleep terrors, SleepwalkingB. Sleep-Wake Transition-Rhythmic movement disordersC. Parasomnias with REM sleep-Nightmares, Sleep paralysis, and REM sleep Behavior disordersD. Other Parasomnias- Bruxism and Enuresis

Parasomnias-BruxismSleep related, stereotyped, forceful teeth grinding or clenchingIs also associated with dementias, mental retardation and Parkinson’s disease

Insomnia-causesMedical and neurological conditionsDrug and alcohol abusePsychiatric disordersPatients older than 65 years of age

Recording of Polysomnography

Simultaneous recordings of EEG, EOG, EMG, EKG, vital signs and breathing

What answers to expect from Polysomnography ?

Polysomnography is a comprehensive recording of the biophysiological changes that occur during the sleepPolysomnography is usually performed during the night when patient sleepsUsually performed with CPAP titration if needed.

Consequences of Abnormal Sleep

- Health Effects- Cost to Employers- Car Accidents

In the early to mid afternoon and in the very early morning hours. These are the times when everyone is least alert.

When do most sleep deprivation car accidents occur?

Women & Sleep:Key Findings Overall

2007 Poll Roadmap

The 2007 Sleep in America Poll findings:

Sleep among women overallThe effect of women’s biology on sleepThe effect of women’s lifestyle on sleep

60%

Women Are Not Getting the Sleep They Need60% say they only get a good night’s sleep a few nights per week or less

Why Are Women Not Getting the Sleep They Need?

67%

67% experience sleep problems at least a few nights each week, with 46% experiencing sleep problems every night

Why Are Women Not Getting the Sleep They Need?

Lifestyle impacts sleepWorking mothers (72%) and single working women (68%) are more likely to experience sleep problems like insomnia

Other factors that wake women upNoise (39%)Giving care to children (20%)Pets (17%)

Why Are Women Not Getting the Sleep They Need?

Women who allow kids (9%) or pets (14%) to share their bed have the most disturbed sleep47% of women say they have no one helping them care for children at night

Consequences of Poor Sleep

Poor sleep and poor mood are intertwinedPoor sleep can worsen mood

Approximately 80% of women report being stressed out, anxious or worried55% state they have been unhappy, sad, and depressed in the last month

Mood can in turn worsen sleep and lead to heightened depression and anxiety

How Women Cope with Poor Sleep… 80% accept daytime sleepiness and keep going65% drink caffeinated beverages

Of those, 37% drink 3 or more caffeinated beverages a day

Although Consistently Tired, Women Do Not Go to Bed Earlier

In the hour prior to bed they :

Combination sleep aid and pain reliever 9%OTC or store-bought sleep aids 6%Alternative therapy or herbal supplements 2%

Anti-depressants prescribed by a doctor 12%Sleep medication prescribed by a doctor 8%

How Women Cope with Poor Sleep…

Compromise: Choices WomenMakeWhen women are tired or run out of time during the day…

Healthy lifestyle activities are sacrificed Forego sleep (52%) and exercise (48%)Reduce time spent with family and friends (39%)Stop healthy eating (37%) Don’t participate in sexual activity (33%)

Work remains a priorityOnly 20% of women put work on the “back burner”

Sleep & Women’s Biology

Women experience more sleep problems than men A woman’s overall health affects her ability to sleep wellAs women progress through different life stages, changing biology affects their ability to get a good night’s sleep

Sleep and Health

Poor health is linked to sleep problems Of women who are in fair to poor health:

66% experience a symptom of a sleep disorder at least a few nights per week40% diagnosed with a sleep disorder46% experience daytime sleepiness a few days per week26% have missed work in the past month54% use a sleep aid a few nights per week

Different Life Stages

Respondents were asked about the quality and quantity of their sleep during 5 reproductive stages

Women of Childbearing AgePregnancyPost Partum Perimenopausal Postmenopausal

Women of Childbearing Age 67% experience insomnia a few nights per week34% report experiencing a sleep disorder such as snoring, sleep apnea or RLS33% say their sleep is disturbed during the week of their menstrual cycle16% have missed work during the past month due to a sleep problem

Pregnant Women

30% say they rarely or never get a good night’s sleep84% have insomnia at least a few nights each week40% report sleep disorders such as snoring, sleep apnea or RLS54% nap at least twice per week

Post Partum Women

This is the first national sleep survey of post partum women.

Post partum women have insomnia at the same rate as pregnant women (84%)42% say they rarely/never get a good night’s sleep, more than any other group 47% report no one helping with kids20% have driven drowsy with kids19% experience post partum blues/depression

Perimenopausal Women

59% have insomnia a few nights per week43% report symptoms of a sleep disorder such as snoring, sleep apnea or RLSNoise (36%) and co-sleeping with pets (20%) are the most common nighttime disturbances 20% experience night sweats and hot flashes

Postmenopausal Women

Have the highest incidence of:Limited time in bed - less than 6 hours (14%) Sleep disorders such as snoring or sleep apnea (42%) RLS (22%) Sleep aid use (41%) Obesity (30%)

Sleep & A Woman’s Lifestyle

Lifestyle and Sleep

Sleep is greatly impacted by lifestyle2007 NSF Sleep in America poll examined sleep among 6 segments of women

Working, Single WomenDINKs and Empty NestersStay-at-Home MomsPart-time Working MomsBriefcases with Backpacks50-somethings

Working, Single Women

Spend the least time in bed, generally less than 6 hours54% wake up un-refreshed a few days each week

70% accept this and keep going47% consume more than 3 cups/cans of caffeinated beverages per dayNearly 30% use the weekends to “catch up” on sleep

DINKs & Empty Nesters

Working married/partnered women with no children or grown children get better sleep than most groups - despite being in bed less than 7 hours per night

Low incidence of sleep problems (15%)Yet, healthy lifestyle choices are still compromised because women are tired or run out of time

46% report having no time for sleep 47% sacrifice exercise38% don’t participate in sexual activity

Stay-at-Home Moms

74% rarely get a good night’s sleep Despite this, 61% say they spend over 8 hours in bed each nightIn the hour before bed, 71% complete household chores and activities with kids

57% nap at least once per week43% curtail leisure activities39% forego sexual activity

Part-time Working Moms

Report getting the best sleep of all the groups50% say they are in bed for over 8 hours per night

68% accept the day’s challenges and keep goingNapping is frequent; 60% take a nap at least once per week

Briefcases with Backpacks

Married/partnered women with school-aged kids, who work full timeSpend less than 6 hours in bed per night72% have insomnia 70% accept sleepiness and keep going

56% use caffeine

Highest rate of drowsy driving (35%)Lifestyle compromises are high

60% give up sleep and exercise52% do not socialize regularly with family and friends44% do not have time for sex

50-somethings

Are not employed, no children at homeHave highest frequency of sleep disordersHighest sleep aid usage (41%)32% say they get a good night’s sleep only a few nights per month

Spend over 8 hours in bed per night and frequently nap

NSF 2007 Poll Overview

American women are…Not sleeping well which affects all aspects of their life- work, relationships, sex?Struggling to “do it all” and as a result sacrifice sleepUsing many coping strategies to sustain the pace of daily lifeImpacted by biological and lifestyle factors affecting their sleep

Insulin resistanceIncreased blood sugarElevated Cortisol levelsSystemic inflammationDisrupted ImmunityImpaired thyroid functionDisruption of your body clock or body rhythmPremature Aging

Why aren’t we sleeping well?

Temperature fluctuations, tossing & turningMental StressDiscomfort & physical stressEnvironmentDiet & lack of regular exercise

Time for Change!

How do we help ourselves?

What Women Can Do?

Make healthy sleep a priority!Make time to get 7-9 hours of sleep Create a relaxing and quiet environment Exercise regularly (not less than 3 hours before bed time) and eat healthyAvoid caffeine and alcohol before bed If you have a new infant, arrange for helpSet a sleep scheduleTry a warm bath before bed

Natural Sleep Solutions:

Sleep Masks/CPAP Ear Plugs

Acupuncture Massage

Meditation/Sleep Therapy Melatonin

Prescription Medications:

Rozarem- melatonin derivativeAmbien/Lunesta- Hallucinogenics

Provigil- for NarcolepsyOthers- GABA receptors- Neurontin/Lyrica

Anti-depressantsHormones? (Estrogen, etc.)

Controversial Topics??

Work Less?

Less Co-Sleeping?

"Cry it Out" Sleep Methods?

What about naps?

Questions?