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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 elderlySlide11
Slide12

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 asleepSlide29
Slide30

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

Watson NF,

Badr

MS,

Belenky

G,

Bliwise

DL, Buxton OM,

Buysse

D,

Dinges

DF,

Gangwisch

J,

Grandner

MA,

Kushida

C, Malhotra RK, Martin JL, Patel SR,

Quan

SF,

Tasali

E. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. 

J

Clin

Sleep Med

 2015;11(8):931–952.Slide33

THANK YOU!

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SLEEP 101: A Sleep Specialist’s Guide to Better Sleep - Description


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 Download Presentation

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