Download - Sleep Presentation
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Sleep Presentation
by Mendy Peterson PA-CApril 23rd 2009
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Objectives:What is Normal Sleep? -circadian rhythm and EEG's -brain and hormones -sex and age patterns Common Sleep Disorders: -parasomnias and insomnia's -sleep apnea & obesity -sleep lab studies Consequences of Abnormal Sleep: -Health -Cost and Employers -Car Accidents -2007 Sleep in America Poll How to Change! -Day & Bedtime routines -Medications & Alternative Meds -Naps
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What is Normal Sleep?
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Cortisol is a hormone released by the adrenal gland that sits on top of the kidney.
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That was
"Cortisol"
NOT
"Caffeine!"
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Theta Waves
Sleep Spindles/K Complex
Delta Waves
More Delta Waves
Dreams!
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Which is better- REM vs Non-REM?
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Hormones and Sleep
TSH - ThyroidCortisol - Adrenal GlandsProlactin - Pituitary/Breast milkGrowth HormoneMelatoninSerotonin - Mood stabilizerEpinephrine - "I am speed!"Estrogen - ahhhh menopause! And..... Many Many more!
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Men vs. Women
Hard Sleep Light Sleep
6 hours 8 hours +
Better Worse
More Less
More Less
More Less
How Hard? How Long?
With Mate?
Sleep Apnea? Sleep Disorders?Car Accidents
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Sleep Questionnair
e
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0 = Would never doze 1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = High chance of dozing Sitting and Reading _____Watching TV _____Sitting inactive in a public place (i.e. theatre) _____As a car passenger for an hour without a break _____Lying down to rest in the afternoon _____Sitting and talking to someone _____Sitting quietly after lunch without alcohol _____In a car, while stopping for a few minutes in traffic _____ A score of greater than 10 is a definite cause for concern as it indicates significant excessive daytime sleepiness. Consider completing full questionnaire and submit to your doctor!
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Sleep Disorders
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SHORTENED SLEEP LATENCY
Alcohol and drug induced sleepNarcolepsySleep apneaSleep deprivation
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Prolonged Sleep Latency
Delayed sleep phase syndromeInadequate sleep hygienePsychiatric disorders-Acute schizophrenia, Major depression, and ManiaRestless leg syndrome
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Causes of shortened or sleep onset REM sleep
Alcohol, sedative and hypnoticsDepressionNarcolepsySleep apneaSleep deprivation
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Sleep disorders in aged
Leg movement disordersREM behavior disorderSleep apnea syndromeMedication induced sleep disordersMedical disorders especially cardiovascular disturbances and painDementiaNeurological disordersDepression
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Dyssomnias-characteristics
Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these. Transient episodes are usually of little significance. Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors
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Dyssomnias-causes
There are over 30 recognized kinds of Dyssomnias. Major groups of Dyssomnias include:Intrinsic sleep disorders - 12 disorders recognized, including
hypersomnia, narcolepsy, periodic limb movement disorder, restless legs syndrome, sleep apnea.
Extrinsic sleep disorders - 13 disorders recognized, including alcohol-dependent sleep disorder, food allergy insomnia, inadequate sleep routine.
Circadian rhythm sleep disorders - 6 disorders recognized, including advanced sleep phase syndrome, delayed sleep phase syndrome, jetlag, shift work sleep disorder
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Dyssomnias-conditions-Narcolepsy
Narcolepsy is a neurological condition most characterized by Excessive Daytime Sleepiness (EDS). A narcoleptic will most likely experience disturbed nocturnal sleep, confused with insomnia, and disorder of REM or rapid eye movement sleep. The main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places Four other classic symptoms of narcolepsy, which may not occur in all patients, are cataplexy, sleep paralysis, hypnogogic hallucinations, and automatic behavior.
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Periodic Limb Movements
Periodic Limb Movement Disorder (PLMD), also called nocturnal myoclonus, is a sleep disorder where the patient moves involuntarily during sleep It is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMD. However, most people with PLMD do not experience RLS Nocturnal myoclonus is treated by medications aimed at reducing or eliminating the leg jerks or the arousals. Non-ergot derived dopaminergic drugs (pramipexole and ropinirole) are preferred. Other dopaminergic agents such as co-careldopa, co-beneldopa, pergolide, or lisuride may also be us These medications are also successful for the treatment of RLS restless leg syndrome.
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Restless Leg Syndrome-types
Primary RLS is considered idiopathic, or with no known cause. Secondary RLS often had a sudden onset and may be daily from the very beginningThe most commonly associated medical condition is iron deficiency (medicine), which accounts for just over 20% of all cases of RLS. The conditions include: pregnancy, varicose vein or venous reflux , folate deficiency, uremia, diabetes, thyroid problems, peripheral neuropathy, Parkinson's disease and certain auto-immune disorders such as Sjögren's syndrome, Celiac Disease, and rheumatoid arthritis. Treatment of the underlying condition often eliminates the RLS.
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Parasomnias-what, why and which ?
A sleep disorder is a physical and psychological condition or disturbance of sleep and wakefulness caused by abnormalities that occur during sleep or by abnormalities of specific sleep mechanisms Although the sleep disorder exists during sleep, recognizable symptoms manifest themselves during the day Accurate diagnosis requires a polysomnogram, widely known as a "sleep test.“
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Parasomnias-classifications
A. Arousal-Sleep terrors, SleepwalkingB. Sleep-Wake Transition-Rhythmic movement disordersC. Parasomnias with REM sleep-Nightmares, Sleep paralysis, and REM sleep Behavior disordersD. Other Parasomnias- Bruxism and Enuresis
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Parasomnias-BruxismSleep related, stereotyped, forceful teeth grinding or clenchingIs also associated with dementias, mental retardation and Parkinson’s disease
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Insomnia-causesMedical and neurological conditionsDrug and alcohol abusePsychiatric disordersPatients older than 65 years of age
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Recording of Polysomnography
Simultaneous recordings of EEG, EOG, EMG, EKG, vital signs and breathing
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What answers to expect from Polysomnography ?
Polysomnography is a comprehensive recording of the biophysiological changes that occur during the sleepPolysomnography is usually performed during the night when patient sleepsUsually performed with CPAP titration if needed.
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Consequences of Abnormal Sleep
- Health Effects- Cost to Employers- Car Accidents
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In the early to mid afternoon and in the very early morning hours. These are the times when everyone is least alert.
When do most sleep deprivation car accidents occur?
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Women & Sleep:Key Findings Overall
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2007 Poll Roadmap
The 2007 Sleep in America Poll findings:
Sleep among women overallThe effect of women’s biology on sleepThe effect of women’s lifestyle on sleep
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60%
Women Are Not Getting the Sleep They Need60% say they only get a good night’s sleep a few nights per week or less
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Why Are Women Not Getting the Sleep They Need?
67%
67% experience sleep problems at least a few nights each week, with 46% experiencing sleep problems every night
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Why Are Women Not Getting the Sleep They Need?
Lifestyle impacts sleepWorking mothers (72%) and single working women (68%) are more likely to experience sleep problems like insomnia
Other factors that wake women upNoise (39%)Giving care to children (20%)Pets (17%)
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Why Are Women Not Getting the Sleep They Need?
Women who allow kids (9%) or pets (14%) to share their bed have the most disturbed sleep47% of women say they have no one helping them care for children at night
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Consequences of Poor Sleep
Poor sleep and poor mood are intertwinedPoor sleep can worsen mood
Approximately 80% of women report being stressed out, anxious or worried55% state they have been unhappy, sad, and depressed in the last month
Mood can in turn worsen sleep and lead to heightened depression and anxiety
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How Women Cope with Poor Sleep… 80% accept daytime sleepiness and keep going65% drink caffeinated beverages
Of those, 37% drink 3 or more caffeinated beverages a day
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Although Consistently Tired, Women Do Not Go to Bed Earlier
In the hour prior to bed they :
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Combination sleep aid and pain reliever 9%OTC or store-bought sleep aids 6%Alternative therapy or herbal supplements 2%
Anti-depressants prescribed by a doctor 12%Sleep medication prescribed by a doctor 8%
How Women Cope with Poor Sleep…
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Compromise: Choices WomenMakeWhen women are tired or run out of time during the day…
Healthy lifestyle activities are sacrificed Forego sleep (52%) and exercise (48%)Reduce time spent with family and friends (39%)Stop healthy eating (37%) Don’t participate in sexual activity (33%)
Work remains a priorityOnly 20% of women put work on the “back burner”
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Sleep & Women’s Biology
Women experience more sleep problems than men A woman’s overall health affects her ability to sleep wellAs women progress through different life stages, changing biology affects their ability to get a good night’s sleep
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Sleep and Health
Poor health is linked to sleep problems Of women who are in fair to poor health:
66% experience a symptom of a sleep disorder at least a few nights per week40% diagnosed with a sleep disorder46% experience daytime sleepiness a few days per week26% have missed work in the past month54% use a sleep aid a few nights per week
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Different Life Stages
Respondents were asked about the quality and quantity of their sleep during 5 reproductive stages
Women of Childbearing AgePregnancyPost Partum Perimenopausal Postmenopausal
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Women of Childbearing Age 67% experience insomnia a few nights per week34% report experiencing a sleep disorder such as snoring, sleep apnea or RLS33% say their sleep is disturbed during the week of their menstrual cycle16% have missed work during the past month due to a sleep problem
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Pregnant Women
30% say they rarely or never get a good night’s sleep84% have insomnia at least a few nights each week40% report sleep disorders such as snoring, sleep apnea or RLS54% nap at least twice per week
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Post Partum Women
This is the first national sleep survey of post partum women.
Post partum women have insomnia at the same rate as pregnant women (84%)42% say they rarely/never get a good night’s sleep, more than any other group 47% report no one helping with kids20% have driven drowsy with kids19% experience post partum blues/depression
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Perimenopausal Women
59% have insomnia a few nights per week43% report symptoms of a sleep disorder such as snoring, sleep apnea or RLSNoise (36%) and co-sleeping with pets (20%) are the most common nighttime disturbances 20% experience night sweats and hot flashes
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Postmenopausal Women
Have the highest incidence of:Limited time in bed - less than 6 hours (14%) Sleep disorders such as snoring or sleep apnea (42%) RLS (22%) Sleep aid use (41%) Obesity (30%)
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Sleep & A Woman’s Lifestyle
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Lifestyle and Sleep
Sleep is greatly impacted by lifestyle2007 NSF Sleep in America poll examined sleep among 6 segments of women
Working, Single WomenDINKs and Empty NestersStay-at-Home MomsPart-time Working MomsBriefcases with Backpacks50-somethings
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Working, Single Women
Spend the least time in bed, generally less than 6 hours54% wake up un-refreshed a few days each week
70% accept this and keep going47% consume more than 3 cups/cans of caffeinated beverages per dayNearly 30% use the weekends to “catch up” on sleep
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DINKs & Empty Nesters
Working married/partnered women with no children or grown children get better sleep than most groups - despite being in bed less than 7 hours per night
Low incidence of sleep problems (15%)Yet, healthy lifestyle choices are still compromised because women are tired or run out of time
46% report having no time for sleep 47% sacrifice exercise38% don’t participate in sexual activity
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Stay-at-Home Moms
74% rarely get a good night’s sleep Despite this, 61% say they spend over 8 hours in bed each nightIn the hour before bed, 71% complete household chores and activities with kids
57% nap at least once per week43% curtail leisure activities39% forego sexual activity
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Part-time Working Moms
Report getting the best sleep of all the groups50% say they are in bed for over 8 hours per night
68% accept the day’s challenges and keep goingNapping is frequent; 60% take a nap at least once per week
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Briefcases with Backpacks
Married/partnered women with school-aged kids, who work full timeSpend less than 6 hours in bed per night72% have insomnia 70% accept sleepiness and keep going
56% use caffeine
Highest rate of drowsy driving (35%)Lifestyle compromises are high
60% give up sleep and exercise52% do not socialize regularly with family and friends44% do not have time for sex
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50-somethings
Are not employed, no children at homeHave highest frequency of sleep disordersHighest sleep aid usage (41%)32% say they get a good night’s sleep only a few nights per month
Spend over 8 hours in bed per night and frequently nap
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NSF 2007 Poll Overview
American women are…Not sleeping well which affects all aspects of their life- work, relationships, sex?Struggling to “do it all” and as a result sacrifice sleepUsing many coping strategies to sustain the pace of daily lifeImpacted by biological and lifestyle factors affecting their sleep
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Insulin resistanceIncreased blood sugarElevated Cortisol levelsSystemic inflammationDisrupted ImmunityImpaired thyroid functionDisruption of your body clock or body rhythmPremature Aging
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Why aren’t we sleeping well?
Temperature fluctuations, tossing & turningMental StressDiscomfort & physical stressEnvironmentDiet & lack of regular exercise
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Time for Change!
How do we help ourselves?
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What Women Can Do?
Make healthy sleep a priority!Make time to get 7-9 hours of sleep Create a relaxing and quiet environment Exercise regularly (not less than 3 hours before bed time) and eat healthyAvoid caffeine and alcohol before bed If you have a new infant, arrange for helpSet a sleep scheduleTry a warm bath before bed
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Natural Sleep Solutions:
Sleep Masks/CPAP Ear Plugs
Acupuncture Massage
Meditation/Sleep Therapy Melatonin
Prescription Medications:
Rozarem- melatonin derivativeAmbien/Lunesta- Hallucinogenics
Provigil- for NarcolepsyOthers- GABA receptors- Neurontin/Lyrica
Anti-depressantsHormones? (Estrogen, etc.)
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Controversial Topics??
Work Less?
Less Co-Sleeping?
"Cry it Out" Sleep Methods?
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What about naps?
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Questions?