Sleep,

Manisha Witmans, MD, FRCPC, FAASM Brainworks Conference 2013

Conflict of Interest •  Previous sleep and research funded by: AIHW, CIHR

•  Medical Director: Sound Sleep Solutions

•  Consultative Services for Stollery Children’s Hospital and Department of Pediatrics, Sleep Medicine and interpretation of ambulatory home testing

Objectives •  To dispel common myths about sleep •  Provide practical tips about good sleep •  Resources for sleep

Myth

Sleep is a Waste of Time

The Evolution •  Thomas Edison: “Sleep is a criminal waste

of time and heritage from our cave days” •  Margaret Thatcher: “Sleep is for wimps” •  Money does not sleep! •  It is not an upgrade option…

BUT SLEEP IS NOT THE ENEMY, WE ARE!!!

Sleep is VITAL •  90 yr old = will sleep 32 years (36% of lifetime)

•  Infant – first year – at least ½ of her/his life sleeping

•  It is as important as AIR and WATER for SURVIVAL!

•  Historically, we knew its importance…not why

Why We Sleep? •  For Restoration

–  Genes turned on during sleep –  Slow wave sleep

•  Energy Conservation –  Only 110 calories saved from not sleeping

•  Brain Processing and Memory Consolidation –  Enhances creativity by 3 fold – synaptic connections strengthened…. –  Brain development - critical

•  Overall – mental function, immune function, growth and tissue repair

SLEEP WAKE

Sleep-Wake Continuum

Sleep IS Important Sleep deprivation can cause: •  Impaired cognitive, social and behavioral performance •  Poor school performance and lower grades •  Tardiness and absence from school/work •  Difficulty remaining alert, less ability to concentrate •  Irritability and impaired mood •  Increases in substance abuse •  Drowsy driving, injury and possibly, death

–  Being sleep deprived is as dangerous as DRUNK DRIVING

Sleep Dysfunction:

Excessive Daytime Sleepiness

Primary Disorders of Excessive Daytime

Sleepiness

Insufficient Sleep (Sleep Deprivation)

Fragmented Sleep (Sleep Disruption)

Circadian Rhythm Disorders

Conceptual Framework

Perception of Sleep Deprivation

Slide  courtesy  of  Dr.  Ruth  Benca  

Myth Sleep loss does not affect me I can make up for sleep deprivation

….6450, 6451, 6452….

I think I can….. I think I can….. I think I can…..

Sleep Deprivation/Loss

•  Weight gain (50% chance of obesity at 5 hrs of sleep) – –  Less loss of fat when dieting if you don’t sleep well (Van Cauter,

Sleep, 2012) –  Risk of obesity with sleep loss in children (Chaput, J Public Health,

2011) –  Increased risk of obesity with sleep fragmentation (Narang, CMAJ,

2013)

•  Injury –  86% increase in risk for injury in 3-5 yr old with < 10 hrs of sleep per

night the night before the accident (boto LR, Sleep Medicine, 2012)

•  Risk taking behavior –  Teens - More likely to gamble (Beebe, 2012)

Sleep Deprivation •  Average sleep time 2013: 6.5 hrs •  Current sleep time 2013: 5 hrs

•  The “at risk”: shift work, teens, jet lag, etc.

•  Microsleeps: your brain coping: 31% drivers will fall asleep at the wheel at least once in their life… can be deadly!!!

Sleep

INCREASES/IMPROVES: •  Attention •  Concentration •  Creativity •  Ability to socialize •  Decision making •  Mental health •  Physical health

DECREASES: •  Mood changes •  Stress •  Impulsiveness •  Fatigue •  Anger •  Inattention •  Risk taking behaviour (drink

and take drugs)

Drowsy Driving and Auto Accidents

•  The peak age for fall-asleep driving accidents is 20 years

www.car-accidents.com/pages/accident_story/3-8-04.html

Myth Sleep, Oh Beautiful and Perfect Sleep

Reality: Shame and Blame •  Bedtime troubles is __________’s fault! •  S/he will outgrow it •  I am the only one affected by it…. •  I need to take care of the other stuff •  I must be doing something wrong •  There must be a magic pill •  Nobody listens or can help

The facts: •  Bedtime troubles are common in children

–  Increased likelihood if developmental disabilities – Can become lifelong

•  Over the counter preparations, although have sleepiness as a side effect may not address the underlying reason for the sleep problem

•  It is best to work with a health professional knowledgeable about sleep to address the concerns

The facts: •  Alcohol and caffeine are not sleep aids. They

disrupt sleep •  Medications in adults do exist but even for

them recommended for short term and in conjunction with behavioral strategies

•  More is not always better – melatonin…

Sleep

Time School start

times

Social pressures

Substance abuse

Hormonal influence,

obesity

Genetic predisposition

Delayed sleep phase

Slide courtesy of Jodi Mindell

Myth: Giving In •  It’s late and I am tired, many nights of this

and I will give in….have the kid come to bed….

The Facts: •  Pick your battles •  Timing can be critical and use it to your

advantage •  This about gains in small increments •  Rome was not built in a day

Myth

Electronics before bed are okay

The Facts: •  Sleep will be more agitated and can hinder

sleep quality •  Children stay up longer, sleep less, and wake

up more

•  The bedroom should only be used for sleep •  The bedroom should be a sanctuary

Myth

Snoring is normal

Snoring is NOT Normal •  Snoring can be a sign that a child/adult has

sleep apnea – Anyone can be affected – Can present as:

•  Increased work of breathing •  Apneas (holding breath during sleep) •  Waking up tired/daytime irritability •  Social/Marital/Academic Problems •  Risk of injury

Snoring is NOT Normal II •  Risk Factors:

– Big tonsils and adenoids (children) – Asthma – Allergies – Family history – Facial features (small jaw, big tongue) – OBESITY – Non-Caucasian

Myth Watching television helps me fall

asleep

Data About Television and Sleep •  Preschool children that watch television before bed

have: –  More disrupted sleep –  More nightmares –  More awakenings –  More bedtime resistance

•  Can cause behavioral sleep issues in children

Myth

I can do whatever I want before bedtime and sleep well

RESULTS: cravings – drugs, stimulants, caffeine, nicotine, alcohol – uppers and downers… an attempt at control…

Myth: Sleep Aids = Training Wheels •  Training Wheels:

– Wibble Wobble Method: Doug Engelbart •  See-saw back and forth •  Feel for the relationship between tilting, steering and

untilting and refining the motion while moving forward

Many other ‘hidden’ caffeine sources.

•  Recommended Maximum Caffeine Intake Levels for Children (Health Canada)

4 - 6 years 45 mg/day 7 - 9 years 62.5 mg/day

10 - 12 years 85 mg/day

Clues to Increased Need for Sleep •  Need an alarm clock to wake up daily •  Excessive use of stimulants •  Need or take naps •  Falling asleep at unexpected times/situations •  Sleeping in on weekends •  Noticeable change in ability to function when

given opportunity to sleep

Getting Enough Sleep •  Nightly sleep needs:

– Most adults need 6-8 hrs – Most children age 8-12 yrs need 9-11 hrs – Most teenagers need about 9.25 hrs

•  Puberty related change in timing of sleep-wake cycle –  Later sleep time and later wake time

Myth

I can do whatever I want before bedtime and sleep well

Data About Television and Sleep •  Preschool children that watch television before bed

have: –  More disrupted sleep –  More nightmares –  More awakenings –  More bedtime resistance

•  Can cause behavioral sleep issues in children

Sleep Disrupters •  Caffeine •  Nicotine •  Alcohol •  Medications •  “Busy bedroom” •  Exercising before bed •  Eating large meals before bed •  Watching television to fall asleep

Sleep Promoting Tips •  Consistent bedtime routine •  Regular exercise earlier in the day •  Avoid a busy bedroom •  Avoid bright light at night •  Avoid stimulating activities before bed •  Avoid the sleep disrupters •  Establish good sleep habits even in your children •  A cool, dark, quiet bedroom

Myths •  Sleep problems are easy to fix with a pill •  There is a magic pill •  Everyone is the same

Conclusions •  Sleep is important and worthy of being

nurtured for good health – Good sleep habits are essential no matter how

old you are •  Sleep can impact many others facets of life

and should not be taken for granted •  Invest in your future – take care of your sleep…