وجعلنا نومكم سباتا و خواب را مایه آرامش شما ساختیم 1 Sleep Disorders and Work 2 Dr Hashemi Occupational Medicine Specialist ID: 775282
Download Presentation The PPT/PDF document " آیه 9 سوره نبأ" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
آیه 9 سوره نبأ(وَجَعَلْنَا نَوْمَكُمْ سُبَاتًا)(و خواب را مایه آرامش شما ساختیم )
1
Slide2Sleep Disorders and Work
2
Dr
Hashemi
Occupational Medicine Specialist
Slide3Sleep is the intermediate state between wakefulness and
deathSleepiness is modulated by a circadian rhythmPacemaker to promote sleep at night and wakefulness during the dayThe internal clock is located in the suprachiasmatic nucleus hypothalmus
3
Slide4Sleep and Performance
Most people most alert at 10 AM-8 PM and most sleepy at 2-4 AMWithin the 24-hour cycle, there are two major nadirs for alertness, during which many people may feel slowed or sleepy: The stronger nadir occurs at night (10 P.M. - 8 A.M., peaking around 4 A.M )The second occurs between 2 P.M. - 4 P.M.
4
Slide5Sleep and Performance
5
Slide6Sleep and Performance
6
The average amount required is
7 - 8 hours
per 24-hour period
If sleep is curtailed, as frequently occurs with today's societal demands,
sleep loss accumulates
This accumulation can be likened to a
debt
For instance, a person who requires 7 hours of nightly sleep for optimal alertness but only captures 6 hours per night will incur a 5-hour sleep debt by the week's end.
Slide7Sleep and Performance
When the debt is large enough or unmasked by boring or passive tasks, one can no longer maintain wakefulness, and involuntary episodes of sleep will occur. These episodes, called micro-sleeps, may be as brief as 5 to 10 seconds in duration and often go unnoticed.
7
Slide8Sleep and Performance
Lapses in performance occur at a rate three to 10 times greater in persons who have been awake longer than 14 hoursPerformance deficits also occur in a dose-dependent manner with accumulating sleep loss or “ debt” .Combined with an increasing sleep debt, performance is at its worst during the circadian nadirs.Demonstrate that monotonous work increases the propensity to sleepiness in a setting of sleep loss and long work hours.
8
Slide9Sleep and Performance
The need for sleep may be unmasked and hard to combat when tasks are long, tedious, or boring. Repetitive tasks increase habituation in a sleepy brain and consequently unmask or augment underlying sleepiness.The fundamental effects of sleep loss permeate all levels of performance and negatively impact the workplace.
9
Slide10Sleep and Performance
Performance deficits can be subtle and first emerge as lapses, omissions, and cognitive deficits. These may be expressed as slowed or inappropriate Decision makingPerseverationJob performanceThoughtMemorySpeedImmediate and recall memory
10
Slide11The Cost of Sleepiness to Society
Driver deaths from single vehicle accidents occurring in the early morning hours
11
Slide12The Cost of Sleepiness to Society
The likelihood of driving while sleepy increased with longer work hours
12
Slide13The Cost of Sleepiness to Society
13
Slide14International Classification of Sleep Disorders
Over 80 known sleep disorders Major sleep disorders likely to produce sleepiness among working adults:InsomniaNarcolepsyObstructive Sleep Apnea ( OSA & OSAS )
14
Slide15Insomnia
Subjective sense that sleep is difficult to initiate or maintain or that sleep itself is non-refreshing.Prevalence :One third of the adult population experiences insomnia Nearly 10% as a chronic problem
15
Slide16Insomnia
FatiguePerformance decrementsMood disturbancesDecreased worker productivityHigher accident rateIncreased morbidityThe workplace can also be a source of stress, which promotes sleep difficulty especially in women.
16
Slide17Insomnia
Precipitating factors are generally listed as the 5 Ps:Physical PsychologicalPsychiatricPharmacologicPhysiologic
17
Slide18Insomnia
Physical : PainIllnessHormonal changesEnvironmental disturbances
18
Slide19Insomnia
Psychological: Psychological stressors Psychiatric: active psychiatric disease
19
Slide20Insomnia
Pharmacologic:Side effect of medications prescribed for other illnessesThrough the arousing properties of caffeine and other CNS stimulantsDirect effect of ethanol ingestionIndirectly as rebound effect following withdrawal of CNS depressants initially prescribed as sleep aids
20
Slide21Insomnia
Physiologic: Circadian change: Jet lag from crossing three or more time zonesRotating shift work
21
Slide22Insomnia
Diagnosis:Diaries of sleep-wake activityObjective polysomnographyActigraphy (a wrist-worn motion detector)
22
Slide23Insomnia
Diaries of sleep-wake activity
23
Slide24Insomnia
POLYSOMNOGRAPHY
24
Slide25Insomnia
Actigraphy (a wrist-worn motion detector)
25
Slide26Insomnia
Treatment:Simple changes in routine, living situation and food intake may be effective. Education regarding the mechanics of sleep (i.e., sleep promoting and interfering behaviors) is important.
26
Slide27Insomnia
Transient insomnia:Lasting a few days to a couple of weeksAssociated with trans-meridian travel, a brief illness, or a stressful event (next day exam or presentation ) Sedatives/hypnotics can be used as the main therapy Shorter acting benzodiazepines Non-benzodiazepine receptor agonistsNew melatonin receptor agonists
27
Slide28Insomnia
Short-term insomnia:Lasting several weeks to a monthUsually associated with more traumatic life events Negative (death of a loved one, divorce, or sudden hospitalization) Positive (marriage, job promotion, or birth of a child)Sedative/hypnotic therapy is indicated over the short termBehavioral therapies and education are important to prevent the development of chronic insomnia
28
Slide29Insomnia
Long-term or chronic insomnia :May last months to yearsThere are well-recognized effective behavioral treatments: Sleep restrictionCognitive therapyRelaxation therapiesStimulus controlBehavioral therapies are typically effective during a 6- to 8-week program Sedative/hypnotic medication should be used as reinforcement for educational and behavioral techniques
29
Slide30Insomnia
Contraindication:Fragile elderlyPregnant womenThose needing to respond to emergencies in the nightFirefighters PhysiciansNatural products:L-tryptophan (amino acid precursor to serotonin)Melatonin (neurohormone secreted by the pineal gland in the dark)Herbs such as valerian root
30
Slide31Narcolepsy
Affecting 0.03% to 0.05% of the worldwide populationJapaneseSymptoms are rare in prepubertal children, with onset peaking in the second decade but continuing into the fifth decade of life.Onset appears to be invoked by stressful life occurrences Death of a loved one Divorce
31
Slide32Narcolepsy
Pentad of primary symptoms: Severe SleepinessCataplexyHypnagogic HallucinationsSleep ParalysisSeverely Fragmented Nocturnal Sleep
32
Slide33Narcolepsy
Severe sleepinessFrequent sleep attacks during which the person cannot fight sleepCataplexy Reversible motor inhibition, triggered by internal or external emotionally laden stimuli and resulting in partial or complete, sudden loss of muscle tone
33
Slide34Narcolepsy
Hypnagogic hallucinations Sleep onset-related auditory, visual, or tactile sensations that may be pleasant or frightening, lasting seconds to minutesSleep paralysisCharacterized by areflexia of skeletal muscles, which may be partial or complete, noted at sleep onset or offsetSeverely Fragmented nocturnal sleep
34
Slide35Narcolepsy
PathophysiologyAutoimmune process that attacks the hypocretin (orexin) system in the hypothalamusHypocretin system is a switch: that is vital to internal monitoring of sleep and wakeHLA DR2 subtypes DR15 (DRB1*1501) and DQ6 (DQB1*0602)
35
Slide36Narcolepsy
DiagnosisCataplexy may be a pathognomonic featureNocturnal polysomnograms followed by a Multiple Sleep Latency Testing (MSLT)Hypocretin-1 levels of cerebral spinal fluid
36
Slide37Narcolepsy
TreatmentPharmacologic and behavioral techniquesPharmacologic techniques:CNS stimulants or wake promoters improve the symptoms of daytime sleepinessAntidepressant drugs (TCAs and SSRIs)Gamma-hydroxybutyrate (sodium oxybate)Certain jobs for which a person with narcolepsy is unfit: Occupations requiring long periods of driving Monotonous attention to critical dials and gauges.
37
Slide38Obstructive Sleep Apnea
The most common disorder resulting in daytime sleepiness among adult workersOSAS is characterized by repetitive episodes of cessation of airflow during sleep, which result in brief arousalsRisk factors:ObesityPost-menopausal
38
Slide39Obstructive Sleep Apnea
PathophysiologyActual cessation (apnea) or the reduction of airflow for brief periods (10 to 60 seconds)Changes in muscle toneRedundant tissueEnlarged tonsils and adenoidsAnatomically small airway passageChanges in the arousal threshold occurring with the ingestion of alcohol or sedating drugsBrief events of apnea can result in significant oxygen desaturations
39
Slide40Obstructive Sleep Apnea
SymptomsSporadic snoring, excessive sleepiness, and restless sleepBed partners are usually sensitive to a marked worsening of nocturnal symptomsCardiovascular consequences: hypertension, arrhythmia, and strokesloss of memory, irritability, depression, and impotence
40
Slide41Obstructive Sleep Apnea
TreatmentContinuous positive airways pressure device (CPAP)
41
Slide42Obstructive Sleep Apnea
TreatmentSurgical :Uvulopalatopharyngoplasty (UPPP)Laser-assisted UPPP (LAUP)Dental devices
42
Slide43Obstructive Sleep Apnea
TreatmentBehavioral techniques :Weight loss Position changes during sleep
43
Slide44Sleep Disorders and Work
44
Apneic and narcoleptic individuals account for 71% of all sleep-related accidents
In
European countries a patient with
untreated OSAS
is considered
unfit to
drive
Slide4545