Why Changing Sleep Habits Needs To Be Your...

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Michael Chee Neuroscience and Behavioral Disorders Program

Duke-NUS Graduate Medical School

Why Changing Sleep Habits Needs To Be Your Business

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Outline

n A call to action on changing sleep habits

n New facts about the benefits of sleep

n Lifestyle changes to ponder and implement

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Overtraining in sports is well known

Physiology of Sport and Exercise 5E Kenny, Wilmore, Costill; Data from DC Nieman 1997

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Economic Impact of Insufficient Sleep

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DistributionofNocturnalSleepDurationInSingaporeanAdolescents

Nocturnalsleepduration

Could be enoughsleep

Not enoughsleep

GooleyJJ(unpublisheddata)

Daytime sleepiness and fatigue

Daytime sleepiness problem Fatigue most or all the time


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OR=2.22(95%CI1.17to4.24)

BMIandoverweight~sleepduration

HigherBMIinshortersleepers Moreoverweightinshortersleepers


Depressionscoresvssleepduration

Higherdepressionscoresinshortsleep Self-harmthoughtsinpreviousweek


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Sleep factoids and tidbits

Sleep stages and electrical activity

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NormalSleepArchitectureInAYoungAdult

Regular Sleeper with Regular Activity Schedule

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A Person At Risk of Poor Outcomes

Sleep Across Life

7 yrs

75 yrs

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Roffwargetal.,Science,1966

Sleep duration across the lifespan

Slow wave sleep declines with age

Children ~40% Young adults ~20%Old adults ~5%

REM declinesIncr. sleep fragmentationOverall drop in quality

Functions of sleep

• Conservation of energy• Restoration of energy supply in neurons• Brain housekeeping• Memory consolidation

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Sleep provides a nightly ‘detox’ for the brain

Memory Consolidation and Evolution with Sleep

§ Sleep also plays an important role in enhancing learning and strengthening memory– Performance on a newly learned task is

often better the next day if adequate sleep is achieved during the night

– Information is repackaged during sleep. – ACTIVE processes at work!

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Sleep is important for MEMORY consolidation

Chan S, Baldeweg T, Cross JH; Epilepsy and Behavior 2011

Consolidation protects memories from forgetting and interference

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REM Sleep May Strip Off Emotions From a Memory

Goldestein AN, Walker MO; Ann Rev Clin Psychol (2014)

What if I don’t sleep enough?

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Foster RG NRN (2005)

Sleep is important for all aspects of health

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Your medicine is ready forcollection - at a 7-Elevenstore

It's basic courtesy to give wayto emergency vehicles

8 All-Time HawkerFavourites Light on CaoloriesHealthHub

Sponsored

Starting school late for all not necessary

PUBLISHED JUL 21, 2017, 5:00 AM SGT!

There is no doubt that starting school later for Nanyang Girls' High School has helped the pupils to concentratebetter but the Government should not rush into extending this to all schools. (No downside to starting schoollate; July 19).

Anecdotally, a higher proportion of Nanyang Girls' High students are chauffeured to school than in otherschools. A later start time would not affect them much.

But for those taking public transport, a later start time would inconvenience both students and working adultsas they would all be travelling at about the same time in the mornings, which would result in packed buses andtrains.

Reports about students having to wake up as early as 5am to cross the border from Johor without compromisingtheir academic performance are also not uncommon.

Ultimately, self-discipline is the key to attentiveness in class,which is also essential when one becomes a working adult.

Lim Chee Khiam

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THE STRAITS TIMESTHE STRAITS TIMESFORUM

The Need for Sleep Studies

• Healthy,nosleeporneuropsychiatricdisorders

• 15-18yearsofage• Highperformingstudents• Regularsleep<8hnight,• Gapof1-2hbetweenweekdayand

weekendsleeptimes

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Sustained attention

285

Psychomotor Vigilance Task

Lo, Ong, Leong, Gooley, & Chee (2016). SLEEP

Speed of processing

31 + 38 =

Mental Arithmetic Task

Symbol Digit Modalities Test


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Mood

Excited

Positive & Negative Affect Scale


Impairing effects of multiple nights of sleep restriction were cumulative

Fri

Mon

Lo, Lee, Teo, Lim, Gooley, & Chee; Sleep (2017).

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Incomplete recuperation after two nights of recovery sleep

Fri

Mon

Wkend


Re-exposure to sleep restriction led to further & faster deterioration in performance


Fri

Mon

Wkend

Wed

Mon

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Associationbetweenself-reportedsleepduration onventricularvolumeandcognition

LoJC;Sleep(2014)

• Averageventricularexpansionrate=3.36%– Plus0.59%foreveryhourofreducedsleepduration

• Averagecognitivechangerate=0.62%– Minus0.67%foreveryhourofreducedsleepduration

Yoong, M; BMC Public Health (2016)

Economic burden of diabetes in Singapore 2010-2050

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Short sleep increases risk for diabetes mellitus

• Confluence of negative effects on glucose tolerance, cortisol, appetitive control and pro-inflammatory cytokines

• Risk increase is about 40% for short sleep <6hrs / night

Sleep loss increases risks of accidents

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III.MakingSleepCount

III.MakingSleepCount

• Haveapre-bedtimeroutine• Controluseofe-devicesandsleeptime• Sleepearlier(ifsleepingpast11pm-midnight)• Managestress• Allowforafternoonnaps• Laterschoolstarttime

see*ChenT;SleepMedicine(2014)

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We need strong action to moderate e-device use

20

Copyrig

ht©20

13Th

eNielse

nCo

mpa

ny.C

onfid

entia

land

proprietary.

SMS

Chat

SocialNetworking

DO 25MINS/DAY 90%

SAY 40%

DO 24MINS/DAY 90%SAY 60%



Source:NielsenInformateMobileInsights2013

ACTIVITIESDONEINLAST30DAYS

WebBrowsing

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Goingtobedearlierisassociatedwithbettergrades

Hysing M; J Sleep Res (2016)

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Afternoonnapscanmakeahugedifferencetovigilance

LoJCetal;.Sleep2017

Biological Delay in

Sleep Time

6hours7hours

8hours

Academics, Social, Media,

Autonomy, Stress

WhyStartSchoolLater?

Start School Later7hours

Fixing this alone is hard and still insufficient

Early Bed Time

Early Rise Time

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Sources: Centre for Disease Control and Prevention website, governmentwebsites, Wikipedia, BBC news, various school websites, forums and blogs.

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If your close friends and loved ones are overweight, you have a 50% chance of also following them

Why you should tell others about sleep

“I just got to try to rest the maximum now. Just make sure I sleep well, even just tonight and tomorrow, really take it easy, so when I do come out on court on Sunday, I have all the energy and all the resources in my mind to play inspired and creative tennis. That's what I've got to do.”

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Acknowledgements

• National Medical Research Council: STaR Award, Far East Organization

http://www.cogneuro-lab.orgPapers available from website

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