sleep and health professor jason ellis. aims 1 – sleep 101 - what is sleep? - what does normal...

Sleep and HealthProfessor Jason Ellis

Aims

1 – Sleep 101- What is Sleep?- What does Normal Sleep Look Like?

2 – Sleep Duration- What is Short Sleep?- What are the Consequences of Short Sleep?- Short Sleep and Obesity

3 – Sleep Quality

- What is Sleep Instability?

4 – A way Forward

What is Sleep?

The issue of short sleep

• For the purposes of this talk, “short sleep” means:– Habitual sleep duration of ≤6 hours

The source of the problem

≤5 hrs 6 hrs 7 hrs 8 hrs ≥9 hrs0

5

10

15

20

25

30

35

7.8

20.5

30.832.5

8.5

% o

f P

op

ula

tio

n

Krueger and Friedman, 2009

Clinical significance of short sleep

Short sleep duration is an issue of pandemic proportions

Short sleep duration is associated with a number of adverse health outcomes:

• Obesity• Hypertension• Hyperlipidemia• Diabetes• Cancer• Mortality

3 4 5 6 7 8 9 ≥101

1.1

1.2

1.3

1.4

1.5

Men

Hours of Sleep

Ha

zard

Ra

tio

Kripke, Garfinkel, Wingard, Klauber, & Marler, 2002

Sleep Duration and Mortality

Obesity and weight gain

• At least 65 studies have shown an association between short sleep duration and obesity

• Several studies have shown that short sleep duration is associated with obesity

Direct

Pro-inflammatory State

Insulin Dysregulation

Indirect

Mood Dysregulation

Impaired Decision Making

Vgontzas, Zoumakis, Bixler, Lin, Follett, Kales, and Chrousos, 2004

Sleep deprivation and TNFα

Vgontzas, Zoumakis, Bixler, Lin, Follett, Kales, and Chrousos, 2004

Sleep deprivation and IL-6

A Common Pathway

Spiegel, Tasali, Penev, and Van Cauter, 2004

Found decreases in leptin and increases in ghrelin

Change in leptin was stronger predictor of changes in hunger than the increase in ghrelin

Sleep Quality

Our Experiment

Protection and Attenuation of Cortical Arousal

Failure and Resultant Sleep Instability

Issues Characterised by Increased Sleep Instability

1) Pain

2) Medication Use

3) Pregnancy

4) Insomnia

Why might Preventative Sleep Medicine be a Way Forward?

One Example (Acute Insomnia)

• Delivery of preventative platform would likely be easier than full CBT-I

• Less conditioned arousal • ‘Self-Schemata’ of insomnia not fully realized

• Reductions in direct and indirect costs associated with chronic insomnia

“An ounce of early intervention with acute insomnia may be worth a pound of CBT-I in the context of chronic insomnia”

Normal Sleeper

(n = 21)

Acute to Remission (n =

19)

Acute to Chronic

(n = 14)

0

20

40

60

80

100

120REM Latency (minutes)

REM Late...

* p<.05* p<.05

0

2

4

6

8

10

12

14

16

18% Slow Wave Sleep

Percentage Slow Wave Sl...

* p<.05

0

1

2

3

4

5

6

7

8

9

10

Depression Scores

Anxiety Scores

* p<.05

* p<.05

Cases of Depression

NS (0---0→1 case)NRs (0→1---1 case) Chronic (0→2→5 cases)

Self-help Pamphlet

Detect – how to record your sleepDetach – stimulus control instructionsDistract – cognitive control and imagery distraction instructions

CBT-I WLC0

5

10

15

20

25

Pre-treatment

Follow-up

Su

bje

cts

Mee

tin

g I

nso

mn

ia C

ase

Cri

teri

a*

* Case criteria defined as >10 on the ISI

One Month:

CBT-I = 60% RemissionWLC = 15% Remission

(χ2=8.64, df = 1, p<.003)

Three Months:

CBT-I = 73.7% Remission

Collaborators from around the World

Dr. Michael Grandner (U Penn)Dr. Michael Perlis (U Penn)Professor Celyne Bastien (U Laval)Dr. Wendy Troxel (RAND Corporation)Professor Dieter Riemann (U Freiberg)Professor Sean Drummond (Monash) Professor Colin Espie (Oxford U)Dr. Maria Gardani (U Glasgow)Dr. Amy Thomson (U Glasgow)Dr. Alice Gregory (U London)Professor Annette Sterr (U Surrey)Dr. Malcolm von Schantz (U Surrey)Dr. Anne Germain (U Pittsburgh)Professor Julia Newton (U Newcastle)

And the people who fund this programme of work

Wall to Wall

The Team

Dr. Vincent DearyDr. Nicola BarclayDr. Mark WetherellDr. Samantha ManDr. Naomi HyndeDr. Greg Elder Dr. Rachel SharmanDr. Zoe GottsUmair AkramAlejandro Sanchez