Joya Paul MD MS NorthShore University HealthSystem Department of Neurology Sleep Disorders November 17 2017 Objectives Review background on sleep and wake Answer some of the most frequently asked questions about sleep ID: 744638
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SLEEP 101: A Sleep Specialist’s Guide to Better Sleep
Joya Paul, MD, MS
NorthShore
University
HealthSystem
Department of Neurology, Sleep Disorders
November 17, 2017Slide2
Objectives
Review background on sleep and wake
Answer some of the most frequently asked questions about sleep
Review pearls on how to get better sleepIdentify factors that can worsen sleepSlide3
Importance of Sleep
25-30% of adults suffer from a sleep disorder
Excessive daytime sleepiness leads to loss of productivity, errors and accidents
Sleep disorders and deprivation lead to other health problems (cardiovascular disease, weight gain, neurological disorders)Slide4
Two Process Model of Sleep
Clock: Circadian Rhythm (Process C); vary by time of day
Hourglass: Homeostatic Drive for sleep (Process H); accumulate sleep needSlide5
Circadian Rhythm
Internal body clock which cycle with a recurring periodicity of approximately 24 hours
Generated by the
suprachiasmatic
nucleus (SCN) located in the anterior hypothalamus; master clock
Controls sleep-wake cycle, body temperature, feeding, hormone secretion, glucose homeostasis and cell-cycle regulationSlide6
Circadian Signals
Promotes arousal and wakefulness
Alerting signal is dominant during wake period and increases throughout the day
Attenuated in the evening (partly by melatonin)Slide7
Homeostatic Drive for Sleep
Sleep Hunger
Builds the longer you are awake
Dissipated by sleepingSlide8
Integrating Homeostatic & Circadian SignalsSlide9
MOST FREQUENTLY ASKED SLEEP QUESTIONSSlide10
How much sleep do I need?
At least 7 hours of sleep per night
6 hours or less sleep per night is inappropriate to support optimal health in adults
Appropriateness of 9 or more hours of sleep per night is uncertain but certain studies suggest that longer sleep duration may be harmfulApplies to all adults (18-65)Varies for infants, children, teenagers and the elderlySlide11Slide12
Do we need less sleep as we get older?
No!
Sleep quality worsens as we age but that does not mean we need less of it
May take longer to fall asleep, may sleep more lightly, wake up more often, spend less time in deep sleepUsually due to other medical illnesses, less exercise, medication effect, napping or sleep disorders (insomnia, osa
,
etc
)Slide13
Is it good or bad to nap during the day?
Good as long as it is no more than 20-30 min
May improve mood, memory, reduce fatigue and stress if done right
Keep it brief and preferably 1-2 hours after lunch when blood sugar and energy levels naturally dropNaps greater than 30 min may leave you more groggy and prevent you from sleeping at nightSlide14
What is the ideal temperature for sleep?
Between 60-67 degrees Fahrenheit
The body’s core temperature must drop 2-3 degrees to initiate sleep
If the core temperature is too high, the brain may not make the switch from awake to sleep or create the best quality of sleepHot bath/shower before bed may bring circulating blood to surface and cool down coreSlide15
Is it bad to eat just before going to bed?
Depends on what you eat
Try to eat dinner 2-3 hours before bedtime
Particular foods to avoid: spicy ones, heavy or rich foods that are difficult to digest, fatty foods (fried), citrus fruits, carbonated and caffeinated drinksLight meals that do not cause intestinal discomfort may be okayConsider elevated head with two pillows to prevent GERDSlide16
Does exercise effect sleep?
Yes and it’s great!
As little as 10 minutes of aerobic exercise regularly can improve the quality of sleep and increase sleep duration
May reduce stress and tire you outBest time would be early morning/afternoon and outdoors to boost your body temperature in the morning and allow you to absorb natural sunlight
Exercising too close to bedtime may over-stimulate the body for some and cause insomnia but not everybodySlide17
Will a “night cap” aide in sleeping?
No; if you booze, you lose
Alcohol may help you fall asleep faster due to it’s sedative effects and provide more deep sleep during the first part of the night
BUT this wears off and sleep quality including REM sleep is negatively affected the second half of the nightWomen are more likely to be affected perhaps because they metabolize alcohol faster
Moderate alcohol earlier in the evening may be okaySlide18
How does Melatonin help sleep?
It helps regulate your sleep cycle
Taking a low dose at the same time every evening helps the body keep a routine
Too much taken at once can cause headaches, nausea, dizziness or irritabilitySlide19
How much caffeine should I drink?
A drop in adenosine signals the body to prepare for sleep
Caffeine mimics the effect of adenosine and tricks the body into thinking that it is not yet time for sleep
Caffeine lasts about 5-6 hours before wearing off but this varies from person to person depending on tolerance, genetics, medications, etc
500mg/day (~ four 8oz cups of brewed coffee)
Avoid caffeine after ~2pm
Drink small amounts every few hours versus a large amount all at onceSlide20
Sleep Hygiene
Habits and practices that are conducive to sleeping well on a regular basisSlide21
Ways to Improve Sleep Hygiene
Increase Homeostatic Drive to sleep
Optimize Circadian factors
Be aware if drug effectsAvoid arousal in sleep settingSlide22
Improve Homeostatic Drive for Sleep
Go to bed only when sleepy
Avoid naps, except for a brief 20-30 minutes nap not in evening
Restrict sleep period to average number of hours you have actually slept per night in the preceding weekQuality of sleep is important. Too much time in bed can decrease quality of subsequent nights
Get regular exercise each day, preferable 40 minutes each day or an activity that causes sweating
It is best to finish exercise at least six hours before bedtime
Take a hot bath to raise your surface temperature within two hours before bedtimeSlide23
Drug Effects
Do not smoke to get yourself back to sleep
Do not smoke after 7:00 pm, or give up smoking entirely
Avoid caffeine entirely for a four-week trial period; limit caffeine use to no more than 3-4 cups no later than 12-2pm
Light to moderate use of alcoholic beverages; alcohol can fragment sleep over the second half of the sleep periodSlide24
Optimize Circadian Factors
Keep a regular wake time out of bed 7 days a week
Get at least one half hour of sunlight within 30 minutes of your out-of-bed time
Do not expose yourself to bright light in the evening or if you have to get up in the middle of the nightSlide25
Avoid Arousals in Sleep Setting
Keep clock face turned away, and do not find out what time it is when you wake up at night
Avoid strenuous exercise after 6:00 pm
Do not eat or drink heavily for three hours before bedtime
A light bedtime snack may help
If you have trouble with regurgitation, be especially careful to avoid heavy meals and spices in the evening
Do not retire too hungry or too full. Head of bed may need to be raised
Keep your room dark, quiet, well ventilated, and at a comfortable temperature throughout the night
Earplugs and eyeshades are OKSlide26
Arousals cont.
Use a bedtime ritual
Reading before lights-out may be helpful if not occupationally related
List problems and one-sentence next steps for the following day
Set aside a worry time. Forgive yourself and others.
Learn simple relaxation techniques to use if you wake at night
Do not try too hard to sleep; instead, concentrate on the pleasant feeling of relaxation
Use stress management in the daytime
Avoid unfamiliar sleep environmentsSlide27
Arousals cont.
Be sure mattress is not too soft or too firm, pillow is right height and firmness
Try not to take sleep medications or aids as they may change normal sleep architecture
Use bedroom only for sleep or sex; do not work or do other activities that lead to prolonged arousal.Slide28
When to send to a Sleep Specialist?
Excessive daytime sleepiness despite sufficient sleep
Loud snoring/gasping at night with pauses in breathing
STOP BANG QuestionnaireFrequent nocturnal arousals
Difficulty falling or staying asleepSlide29Slide30
What patients can expect?
Extensive history regarding sleep problem, medical health and mood
Sleep logs/diaries
Overnight sleep study and/or daytime sleep studyActigraphySlide31
Common Sleep Disorders and Treatments
Snoring (oral device, ENT procedures)
Sleep apnea (CPAP machine, oral device,
ENT procedures)Insomnia (improve sleep hygiene, address stress/mood, cognitive behavioral therapy)Parasomnia (safety and medications)
Sleep related movement disorders (medications)
Circadian rhythm disorders (light therapy)
Hypersomnia (stimulants, scheduled naps)Slide32
Which of the following is true regarding how much sleep a healthy adult (age 18-65) should get per night to avoid the negative consequences from sleep deprivation?
A. Adults should get less than 6 hours of sleep per night
B. Adults should get at least 7 hours of sleep per night
C. Adults should get more than 9 hours of sleep per night
D. The amount of sleep an adult should get depends on their age
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THANK YOU!