Waking up to the power of sleep: evidence-based solutions for insomnia

Prof Colin A. Espie BSc, MAppSci, PhD, DSc, FBPsS, CPsychol, CSci

Professor of Sleep MedicineDirector of Experimental & Clinical Sleep ResearchClinical Director of Oxford Online Programme in Sleep MedicineSleep & Circadian Neurosciences InstituteNuffield Department of Clinical NeurosciencesHonorary Senior Research Fellow, Dept of PsychiatryFellow, Somerville CollegeUniversity of Oxford

Emeritus Professor of Clinical PsychologyUniversity of Glasgow

Plan

• Sleep is universal and essential- There can be major consequences to insufficient sleep- Insufficient sleep can result from lifestyle choices or from a sleep disorder

• Sleep is complex- Sleep has its phases and stages - It varies across our lifespan and it varies by person

• Value your sleep- Prioritise and protect it- Get help if you have a sleep disorder

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

General activities

19%Sleeping36%

Data from - American Time Use Survey Summary 2011

Watching TV11%

Household work8%

Eating &Drinking

11%Socialising

3%

Sport/Exercise1%

Telephone/Mail/Email

1%

Lifetime Behaviour

http://www.bls.gov/tus/

Work & Work related

16%

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Sleep is essential: not a “nice to have”

• For all creatures• Total amounts and

timing of sleep vary by species

• Experimental animals die in 11-32 days if deprived of sleep

Cirelli & Tononi, 2008; Everson et al, 1989

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Our debt to sleep

Cell regeneration

Protein synthesis

Immune signaling

Emotion regulation

Learning and memory

Cirelli & Tononi, 2000; Zie at al, 2013; Siegel, 2008; Imeri & Opp, 2009; Cappuccio et al, 2010; Kahn et al, 2013; Stickgold, 2005; Diekelmann et al, 2009

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Sleep deprivation and circadian misalignment confer significant risk

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Drowsy driving? …. Me?

• Difficulty focusing, frequent blinking, or heavy eyelids• Daydreaming; wandering/disconnected thoughts• Trouble remembering the last few miles driven; missing exits or traffic signs• Yawning repeatedly or rubbing your eyes• Trouble keeping your head up• Drifting from your lane, tailgating, or hitting rumble strip• Feeling restless and irritable• Impairment to recognition of sleepiness and failure to act

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

REM sleep: EEG, EMG, and EOG characteristics

Atonia

Phasic twitches

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Sleep architecture changes over the lifecourse

Ohayon M, Carskadon MA, Guilleminault C, et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004;27:1255-1273.

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

InternationalClassificationofSleepDisorders(ICSD-3)

SleepRelatedBreathingDisorders

SleepRelatedMovementDisorders

CentraldisordersofHypersomnolence

Parasomnias

Insomnias

CircadianRhythmSleep-WakeDisorders

Disorders of sleep

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Insomnia treatment guidelines

19992006

20172016

2005 20102019

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

European Insomnia Guideline2017

uCognitive Behavioural Therapy (CBT) is recommended as first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence).

uA pharmacological intervention can be offered if CBT is not effective or not availableRiemann et al JOSR (2017) DOI: 10.1111/jsr.12594

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Based on Espie & Kyle (2012).Chapter 12: Cognitive Behavioral and Psychological Therapies for Chronic Insomnia; Therapy in Sleep Medicine ed. Barkoukis et al.

CBT is a system of evidence-based therapeutics for insomnia

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

“Consumer sleep technologies are changing the landscape of sleep health and clinical sleep medicine. These technologies have the potential to both improve and impair collective and individual sleep health depending on method of implementation”

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

“This review highlights recent developments in consumer and clinicaldevices for sleep, emphasizing the need for validation at multiple levels, with the ultimate goal of using personalized data and advanced algorithms to provide actionable information that will improve sleep health”

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

8 published RCTs n ~ 3,100 participants

8 published RCTsn ~ 6,900 participants

2019

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

Some advice to establish healthy sleep

1. Work out how much sleep you need2. Consider best sleep period time for you (owl/ lark?)3. Establish your pattern and protect it4. Maintain good ‘sleep hygiene’5. Put the day to rest6. Never try to sleep7. If you have a sleep disorder get it treated

Ó Prof Colin Espie, University of Oxford, 2019. All rights reserved. Not for distribution without permission

The Oxford Online Programme in Sleep MedicineColin Espie, Simon Kyle, Christopher-James Harvey, Sumathi Sekaran,

Nicola Barclay, Marion Greenleaves

• Leads to a MSc, PGDip or CPD• 8 Sleep Medicine Modules (+2 research skills)• Recorded lectures & live online seminars• Started Oct 2016• Health professionals from 31 countries

Experimental & Clinical Sleep Medicine

Prof Colin EspieAssoc Prof Simon KyleDr Chris HarveyDr Nicola BarclayDr Ximena OmlinDr Rachel SharmanDr Gaby IllingworthDr Sumathi SekaranDr Jules Schneider

Dr Jenna CarlDr Jen KanadyDr Michelle DavisDr Chris MillerDr Alasdair HenryDr Richard StottDr Jenny Gu

Dr Dimitri GavriloffDr Laura MitchellDr Claire SextonDonna LittlewoodHeather CondonMatt ReidLeonie MaurerAmender JussMadeleine Hurry Honorary

Prof Dieter Riemann (Freiburg)Dr Phil Gehrman (UPenn)Dr Annemarie Luik (Amsterdam)

Waking up to the power of sleep: evidence-based solutions for insomnia

Prof Colin A. Espie BSc, MAppSci, PhD, DSc, FBPsS, CPsychol, CSci

Professor of Sleep MedicineDirector of Experimental & Clinical Sleep ResearchClinical Director of Oxford Online Programme in Sleep MedicineSleep & Circadian Neurosciences InstituteNuffield Department of Clinical NeurosciencesHonorary Senior Research Fellow, Dept of PsychiatryFellow, Somerville CollegeUniversity of Oxford

Emeritus Professor of Clinical PsychologyUniversity of Glasgow