Kristen Knutson, PhDAssociate ProfessorCenter for Circadian & Sleep MedicineDepartment of Neurology

Sleep Health:what is it, why does it matter, & how do you get it?

Today, we will discuss:What is Sleep Health?•How much sleep people should get•Common sleep disorders

Why does it matter?•Consequences of poor sleep health

How do you get it?•Sleep health tips & resourcesQ&A

What is Sleep?

Sleep is divided into stages

• Rapid Eye Movement (REM)− Bursts of rapid eye movements− High brain activity− Lack of muscle tone

• Non-Rapid Eye Movement (NREM)− Stage 1 (“drowsy”)− Stage 2− Stage 3 (“deep sleep”)

EEG

EOG

EMG

REM = paradoxical sleep (active brain in dead body)

EEG, EOG & EMG in all stages

2nd half

1st half

Sleep cycles through stages throughout the night

Wake

REM

Wake

Stage 1

Stage 3

Stage 2Stage 2

Stage 3

Stage 2

Stage 1

Stage 2

REM

Amount of time in each stage is not equal

Spend most time in Stage 2

52%25%

15%

Sleep patterns and characteristics change over the life cycle.

Newborns/Infants More active in sleep; 50% REM; several periods of sleep; need naps

Toddlers Sleep begins to resemble adult patterns

Children Experience more deep sleep

Adolescents Shift to later sleep-wake cycle; experience daytime sleepiness

Adults Need regular sleep schedule to obtain sufficient, quality sleep

Older Adults More likely to have medical problems; sleep disrupters & disorders; sleep less efficiently

© Copyright 2003 National Sleep Foundation

Regulation of Sleep: 2 processes

Sleep regulation - balance between two processes.sleep

wak

e

9am 9am

Sleep

What is healthy sleep?• Amount of Sleep• Quality of Sleep

Recommendation for sleep latency (how long it takes to fall asleep)

≤30 minutes is appropriate but over 45 minutes is not.

Ohayon et al, Sleep Health: Journal of the National Sleep Foundation 2017 3, 6-19.

(65+ years)

Recommendation for number of awakenings (>5 min)

4 or more awakenings are inappropriate

Ohayon et al, Sleep Health: Journal of the National Sleep Foundation 2017 3, 6-19. (65+ years)

Recommendation for amount of time awake after having fallen asleep

For adults <65 years old, spending 20 minutes awake (or 30 minutes for 65+ year olds) is appropriate.

Ohayon et al, Sleep Health: Journal of the National Sleep Foundation 2017 3, 6-19.

(65+ years)

Sleep & Aging

Sleep changes as we age:- Sleep often becomes lighter- More awakenings- Get sleepy earlier in the day and wake up earlier- Sleep disorders become more common

This does not mean you mustput up with poor sleep!

Sleep Disorders

Sleep Disorders

Sleep Disorder Physician SpecialtySleep Apnea Sleep Medicine; PulmonologistInsomnia Sleep Medicine; Clinical

PsychiatristNarcolepsy Sleep Medicine; NeurologistRestless Legs Syndrome Sleep Medicine; NeurologistREM Sleep Behavior Disorder Sleep Medicine; NeurologistParasomnias (e.g. sleep walking)

Sleep Medicine

Obstructive Sleep Apnea

What is apnea?• Pauses in breathing due to blocked airway • Causes gasps and awakenings during sleepWho has apnea?• 18 million people• More often men• Those who are overweight • Those with high blood pressure Why is it bad?• Lowers oxygen levels in blood• Puts a strain on the heart• Associated with heart problems and daytime

sleepiness

© Copyright 2003 National Sleep Foundation

Treatment of Obstructive Sleep Apnea

Behavioral TherapyAvoid alcohol, nicotine and sleep medicationsLose weight if overweight

Physical or Mechanical TreatmentPAP (Positive Airway Pressure)Dental appliance

SurgeryUpper airway stimulation (UAS) via implant

© Copyright 2003 National Sleep Foundation

Insomnia

Symptoms:• Trouble falling asleep,• Trouble staying asleep, or• Waking too early and can

not go back to sleep• Problems with daytime function.

23

Prevalence of Insomnia• 30-40% of adults have experienced some level of insomnia• 10-15% of adults report chronic or severe insomnia

Mild or Transient

Severe or Chronic

Normal Sleep Pattern

Risk factors for insomnia

• Being Female− 50% more likely to develop insomnia than

men.• Older ages−Up to 64% of people over 65 years of age.

• Occupational:−Working outside traditional hours (e.g. 9-5)

• Lower socioeconomic status

Perpetuation of Insomnia – the 3 Ps

PREDISPOSING

PERPETUATINGPRECIPITATING

e.g. Hyperarousal

Illness, Medications, Alcohol, Stress, Shift work

Sedentary lifestyle, poor sleep hygiene, worry about sleep

Treatment of Insomnia

*Behavioral Management*Cognitive Behavioral TherapyRelaxation TrainingMindfulness Based Therapy

MedicationOver-the-Counter Prescription Medications

Speak with a doctor before taking any medication.

Narcolepsy

• Neurologic disorder characterized by a decreased ability to regulate sleep-wake cycles.

• Affects 1 in 2000 people• Symptoms: − excessive daytime sleepiness that leads to an irrepressible need to sleep− daytime lapses into sleep. − sudden muscle weakness when experiencing an intense emotion such as

laughter (cataplexy) − vivid dream-like hallucinations while falling asleep or when waking up − feeling completely paralyzed when waking up or falling asleep (sleep

paralysis).

Narcolepsy - Video

https://youtu.be/jTj3a2nHw8k

Video from PBS story about narcolepsy researcher at Stanford, Dr. Emmanuel Mignot.

Narcolepsy Treatments

Medications to treat:•Daytime Sleepiness (stimulants)

•Cataplexy

Scammell, Narcolepsy, New England Journal of Medicine (2015)

Recognizing Sleep Problems and Disorders

32

If you are concerned about your sleep, tell your doctor!

Why Does Sleep Health Matter?

Sleep: It does a body good

Sleep

Cognitive Function

Mental health

Brain UpkeepImmune

Function

Cardio-vascular Function

Metabolic Function

Endocrine Function

Accidents

Memory/Learning

Alzheimer's Disease

Diabetes

Obesity

AppetiteHypertension

Cardiovascular Disease

Infectious Disease

Cancer

Risk taking

Anxiety

Depression

Quality of Life

Effect of sleep loss on performance

• The longer they restrict sleep, the worse they get.

# of days

# M

ista

kes

0 hours in bed4 hours in bed6 hours in bed8 hours in bed

The less you sleep = the faster you deteriorate.

von Dongen et al, Sleep, 2003

What’s the relevance?

•How does impairment in performance, i.e. “lapses”, translate to the real world?Accidents!

Driving While Sleep Deprived = DUI

• Driving after being awake for 17 hours = driving with blood alcohol level of .05%.

• If you wake up at 7AM, this would = driving at midnight.

Dawson & Reid, Nature 1997Blood Alcohol Concentration

Perfo

rman

cePe

rform

ance

# of Hours Awake

I don’t need much sleep. I feel fine.

•No association between how a person felt after sleep deprivation & how they performed.

Leproult et al, AJP 2003

Effect of sleep on immune function• Effect of sleep restriction on response to flu shot.

• 25 healthy young men• Compared 4 nights of 4h in bed to 7.5-8.5 h

• Response to flu shot reduced by more than half.

Spiegel et al, JAMA 2002

0

0.5

1

1.5

2

2.5

Day 0 Day 10

Mea

n An

ti-In

fluen

za Ig

G Ti

ters

x 1

06 Antibody Response to Flu Vaccine

4h~8h

Effect of sleep on appetite

• Hormones that regulate appetite changed.• Increase in hormones that increase appetite.• Decrease in hormones that decrease appetite.

• Volunteers’ subjective feelings of hunger and appetite also increased.• Increased for all food types, but not all food types increased

equally.

Spiegel et al, JAMA 2002

Effect of sleep on appetite

Appetite for which food increased more?

OR

How do I improve my sleep?

Sleep Tips

Establish a regular sleep schedule.•Having a consistent bedtime helps your body prepare for sleep before you go to bed.

During the day:• Avoid caffeine− especially in late

afternoon/evening• Avoid alcohol− Especially right before

bedtime.• Avoid nicotine− Especially before bed.

Sleep Tips

Sleep Tips

Establish a sleep-friendly bedroom.

• Quiet− Electronics off; earplugs or white noise

• Dark− Eye mask, blackout curtains

• Cool but comfortable (~68°).• Reserve bed for sleep and sex

(no working!)

Sleep Tips

Avoid bright electronic devices before bedtime

• Takes longer to fall asleep • Reduces levels of the sleep-promoting

hormone melatonin • Reduces the amount and delays the

start of REM sleep • Reduces alertness the following

morning

Chang et al, PNAS 2014

Brochures

For more information:

• National Sleep Foundation: https://www.sleepfoundation.org/− They are dedicated to improving health and well-being

through sleep education and advocacy.• Project Sleep: https://project-sleep.com/− Mission: provide sleep disorder help, via raising awareness

about sleep health and sleep conditions.• Sleep education: http://sleepeducation.org/− This website has articles and information about sleep.