Technology’s Impact on Healthy Sleep

JEFFREY S. DURMER, MD, PHD

Adjunct Professor, Georgia State Univ.Chief Medica l Off icer, Fus ionHealth, At lanta, GA

AgendaHow Technology Detracts from Your SleepHow Technology Benefits Your SleepEmerging Technologies To ConsiderQuestions & Discussion

What We Mean by Technology“a combination of domain specific & applied scientific knowledge in the development of innovative solutions to practical problems”

In the context of “sleep”, technology’s impact is not limited to medical or scientific technology, but also to readily available consumer-based technologies that pervade society.

How Technology Detracts from SleepLight Emitting Devices (especially in blue-green wavelength)

- Stimulate Wake

- Deactivate Sleep- Stimulate Information and Novelty Seeking behaviors- Stimulate Movement and Temperature- Stimulate Appetite and Change Energy Balance

Understanding How Technology Detracts from Sleep

2011 National Sleep Foundation’s Sleep in America Poll- 1,508 Americans interviewed and matched to 2009 US Census data- 47 Semi-Structured Sleep Habits survey

Results: 90% of Americans use a technology device in the hour before bedtime (60% of all TV; 72% adolescents mobile phone)The more interactive tech devices used (computer/laptop, mobile phone, video games) the more difficulty falling asleep and unrefreshing sleepSleep onset was much later in younger vs older adults

Gradisar M, et al. The sleep and technology use of Americans: findings from the NSF’s 2011 Sleep in America poll. JCSM 2013;9(12):1291-9

Understanding How Technology Detracts from Sleep2011 National Sleep Foundation’s Sleep in America Poll

Gradisar M, et al. The sleep and technology use of Americans: findings from the NSF’s 2011 Sleep in America poll. JCSM 2013;9(12):1291-9

Understanding How Technology Detracts from Sleep

Technology use and Sleep Quality in Preadolescence & Adolescene- 850 children Self-Report technology use, sleep wake behavior, circadian preferences- Structured Self-Report scales: School Sleep Habits Survey, Mobile Phone Involvement Questionnaire, Shorter PromisQuestionnaire

Results: Evening circadian preference, mobile phone and internet use, the number of other activities after 9:00pm, late turning-off time and number of devices in the bedroom all have a negative impact on sleep quality.

Bruni O, et al. Technology use and sleep quality in preadolescene and adolescence. JCSM 2015;11(12):1433-41

Understanding How Technology Detracts from Sleep

Technology use and Sleep Quality in Preadolescence & Adolescene

Bruni O, et al. Technology use and sleep quality in preadolescene and adolescence. JCSM 2015;11(12):1433-41

Understanding How Technology Detracts from SleepActual Sleep Times in the US

https://jawbone.com/blog/circadian-rhythm/ (n=1,000,000 UP wearers) http://www.gallup.com/poll/166553/less-recommended-amount-sleep.aspx(n=1,031 random sampled adults)

Understanding How Technology Detracts from SleepCDC Healthy People 2020

Youth Risk Behavior Surveillance System (YRBSS), CDC/NCHHSTP; National Health Interview Survey (NHIS), CDC/NCHS

69%31%!!

How Does Technology Detract from Sleep?

First you need to understand a little of the basic biology of sleep and wake to understand the impact (good or bad) that technology can have on this fundamental biological activity.

How the Brain “Wakes Up”Image detection:Rods (Black& White distributed)Cones (Color – macula)

Luminance:ipRGC (melanopsin)

Intrinsically Photosensitive:Retinal Ganglion Cells (ipRGC)

Intrinsically Photosensitive Retinal Ganglion Cells

(Barinaga Science 2002, 295:956)

Retinal Ganglion Cells Activate SCN

(Kalsbeek & Buijs, Cell Tissue Res, 2002)

SCN Activates “Wake Centers” & Shuts Down “Sleep Centers”

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The “Wake Switch”- Hypocretin/Orexin neurons in the Lateral Hypothalamus

(Baumann & Bassetti, Sleep Med Rev, 2005)

Light Activates Circadian “Wake System” & Shuts Down the “Sleep System”

How Technology Detracts from Sleep

The Light from Your Cell Phone = Melatonin Suppression & Disruption

Melatonin is produced in the brain during sleep and increases throughout the night

Light suppresses Melatonin production and alters sleep signaling

The Light from Your Cell Phone = Appetite Stimulation & Weight Gain

Hypocretin/Orexin is a potent wake promoting neurotransmitters that also stimulates food intake

Sleep deprivation: Leptin and Ghrelin are regulators of energy balance signaling

Dampens the circadian rhythm of LeptinIncreases the release of Ghrelin – increases food intake

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Dark- Cool- Quiet- Continuous- Calming the Mind- Relaxing the Body- Training the Brain to Sleep

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Dark

Removal of Light Emitting DevicesOrange lightsOrange glassesNight-light phoneLight attenuating devices

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Cool

Smart House ThermostatsCooling Pads Airflow devices

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Quiet

Natural soundsAir Flow – FansNoise cancelling technologySound attenuating technologyConductive Auditory Stimulation

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Continuous

Whatever technology you use, must be in place continuously through the night

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Calming the Mind

Guided ImageryCognitive RestructuringMindfulness Meditation

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Relaxing the Body

Segmental Muscle RelaxationMindfulness MeditationAroma therapyRestorative YogaConductive Auditory Stimulation

Understanding How Technology May Help SleepEnhancing sleep through technology means producing the best environment for sleep:

- Training the Brain to SleepOnline CBTi

Circadian Modeling

Light & Therapy

Emerging Technology and SleepPopulation Sleep-Health Programs

- Large scale digital sleep-health risk screening- Home-based assessments (Medical & non-Medical)- Digital medical evaluation & consultation- Passive sleep-health device & therapy surveillance- Algorithmic issue escalation to sleep-health professionals- Personalized programming & individualized outcomes- Wellbeing vs disease focused

Remote Digital Sleep Management

Questions & Discussion

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