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