To Sleep or Not to Sleep…

May 6 2010 D. Nesdoly MD FRCPC

Consequences of Sleep Loss

Scenarios

Scenarios01230123

04000149

Objectives

Sleep Science historySleep Mechanics 101Sleep Deprivation ConsequencesShift-work risks ‘evidence’

Strategies Future research

Sleep Science History

1930 Berger- “Father of EEG”1937 Loomis- first overnight EEG human sleep recordings

1968 Standardized manual1974-Williams normative sleep data

2010-Accreditated Sleep Centers

Sleep Basics 3

Mechanisms ANS

PNS SNS

Homeostatic Sleep Drive

Circadian Sleep Rhythm

Sleep Stages

Sleep Waves

Sleep Architecture

ircaCircadian Sleep

Disorders

Sleep Quantification

ObjectiveMSLTMWTPVT

SubjectiveSleepiness scales

Stanford (1973 7 point)

Karolinska (1990 9 point)

Epworth (1991 situation-specific dozing likelihoods)

Effects of Sleep Deprivation

Recovery Studies

Shift-work Syndrome

Prevalence(U.S.-22 M SW +3% )Canada 11% rotating, 6% evening, 2% nights

Prototype Insomnia / Sleepiness Fatigue / Headache / Anxiety Indigestion / Pyrosis Hypertension Weight gain Menstrual irregularity / Sub-fertility / SA Depression Drowsy driving

Sleep Deprivation Impact

IndividualFamilyCommunitySociety

Shift-work Impact

Shift work + Cardiovascular Disease

Modest (+) associations w shift work (40%)

Causal link research inconsistent Daylight Saving Time *

Janszky (2008) Acute MI risk Mondays“Spring” Incidence ratio 1.051“Autumn” Incidence ratio 0.985

Shift work (LAN) + Cancer

Schernhammer (2001) Nurses Health Study Cohort240,000 women over 30 yearsControl for major risk factors, stress, SE statusCancer relative risk

Breast 36-79 %Colon 35%Endometrial 43%

2007 IARC classifies ‘night shift work’ as probable carcinogen (2A)

Shift work (LAN) + Cancer

Observational studies: modest (+) relationship b/w LAN + breast Ca

Pukkala (1995) Flight attendants > 15 YTynes (1996) Radio + telegraph operators

Prostate Ca Airline pilotsFirefightersHealth practitioners + physicians

Circadian Disruption Shift

work + Risk of CaSeattle Research group

LAN + Breast Ca Case control study60-Hz magnetic fields + nocturnal melatonin

Night shift work + biomarkersMelatonin + hormonesGenotypes (hCLOCK, Per2, Per3)

Shift work + Pregnancy

Moderate (-) effect on fetal growthSGA / LBW

No association for pre-term delivery or pre-eclampsia

Study Limitations

Epidemiologic vs RCTSelection bias

“Survivor population” (entrance + drop-out)

Lower socioeconomic statusShift work definitionExposure measurement

Shift Work Proposed Mechanisms

Shift-work + Risk

Needle-stick eventsAyas (2006) Trinkoff (2007)

Clinical performanceHoward (2003)-AnesthesiaLockley (2004)-ICUSmith-Coggins (2006)-Emergency

Transportation Safety

Prototype ‘drowsy driver’Young male < 25Shift-workerUntreated sleep disorder (OSA / Narcolepsy)

Event 2400-0700Social Media: “Contagious”

Transport + Sleep Deprivation

CommercialTruckRailAir / ATC

Performance impairment = Ethanol intoxicationDawson 1997Powell 2001Vakulin 2007

Drowsy Driving Strategies

AwarenessLegislationHighway rumble stripsOperator behavior

NapsCaffeineEnvironmental stimuli

Sleep Loss Countermeasures

PharmacologicNon-pharmacologic

Sleep Loss CountermeasuresPharmacologic

AntihistaminesBenzodiazepinesNon-benzodiazepinesAntidepressants

Serotonin modulator SSRIS SNRI Tetracyclic Tricyclic

Melatonin receptor agonistAlternative

Valerian Kava Chamomile Synthetic melatonin

Non-pharmacologic

Sleep Loss Countermeasures

PharmacologicNon-pharmacologic

BehaviouralSleep deprivationReconditioningRelaxation techniquesCBT

Schedule strategiesRestrict maximum 3 consecutive shifts

Forward shift rotationParticipatory approach

Wolkove, N. et al. CMAJ 2007;176:1449-1454

Sleep Hygiene

Future Research

Common definitions (SW)Common assessment (exposures)

Study intermediate pathways vs disease outcomes

Outcome data NOT biomarkers

Summary

Sleep science ‘101’Sleep debt awarenessSleep hygiene / ‘art’ of sleeping

Drowsy driving KILLS people

Reference List

Any Questions?Erica

A baby friendly way to establish

To Sleep or Not to Sleep…

Documents

Transcript of To Sleep or Not to Sleep…

Not enough sleep at home

Not getting enough sleep

1 Copyright 2008 CIGNA HealthCare – Confidential & Privileged – Not for Distribution Sleep Well: How to Get a Good Night’s Sleep Presented by CIGNA Employee.

Sleep APNOEA INFORMATION BOOKLET€¦ · Healthy Sleep Tips 10 Things You Should Know About Smoking, Snoring & Sleep Apnoea Paediatric Sleep Disorders Why not join the Sleep Disorder

Now Go To Sleep! Sleep Disorders In SUDs & Recovery Fully Rested - Gets Up Easily Not Sleepy During Day Good Mood 1.

Management of Sleep Problems in Infants and Toddlers Oshikanulu - CPHVA... · Sleep Problems in Infants and Toddlers ... Common Toddler Sleep Problems • Toddler does not sleep after

sleep. growth hormone and cortisol secretion during...sleep onset to the first occurrence of slow wave sleep was not affected. In contrast, rapid In contrast, rapid eye movement sleep

Lack of Sleep Journal Entry & Sleep Disorders. TRUE or FLASE? 1.Everyone needs 8 hours of sleep a night. 2.Sleep patterns are not genetically influenced.

Hibernation. Hibernation Hibernation is a time when animals sleep through the winter months. The sleep is not how you and I sleep, but a very deep sleep.

Breakfast for spouse - not getting enough sleep - brainstorming

Story telling - Not getting enough Sleep

Pharmacotherapy of Sleep Disorders · specific reasons to suspect a primary sleep disorder, or if the insomnia does not respond to routine care • Unsuspected primary sleep disorders

Sleep Deprivation and Delirium in ICU patients · Sleep deprivation “Sleep deprivation is the condition of , not having enough sleep which adversely affects t he brain and cognitive

SLEEP OR M BABY · SLEEP OR M BABY Make Every Sleep a Safer Sleep We’re not sure who came up with the expression, ‘sleep like a baby,’ but we’re

REST! Yes, even YOU need to sleep!. Not enough sleep could = Obesity Heart disease Diabetes Headaches .

Mild Sleep Apnea –To Treat, or Not to Treat?€¦ · –“I think I don’t sleep well” –Not frankly tired; ESS 6 –Reports irritability, memory worsening –Bloodwork(including

The Benefits for NOT going to Church… Get to catch up on lost sleep!

Secrets of Building 7 Sleep, Perchance to Research · A sleep-deprived person may still function, but not as efficiently as someone who gets enough good-quality sleep, and they may

Barnsley Sleep Toolkit · think it may be down to not sleeping enough. This is where “sleep hygiene” comes in. Don’t be confused by the phrase ‘sleep hygiene’, it’s not

A Hotel Is Not Just A Place To Sleep