sleep architecture remrapid eye movement nremnon-rapid eye movement stages 1 and 2 light sleep...
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Sleep ArchitectureSleep Architecture
REMREM Rapid Eye MovementRapid Eye Movement
NREMNREM Non-Rapid Eye MovementNon-Rapid Eye Movement
Stages 1 and 2 light sleepStages 1 and 2 light sleep
Stages 3 and 4 deep sleepStages 3 and 4 deep sleep
25% REM, 50% Stage 2 and 25% stages 3 and 425% REM, 50% Stage 2 and 25% stages 3 and 4
FatigueFatigue
Effect of fatigue/sleep deprivationEffect of fatigue/sleep deprivation
• IncreasedIncreased irritability and lower stress toleranceirritability and lower stress tolerance
• Low motivation (“Can’t be bothered”)Low motivation (“Can’t be bothered”)
• Faulty judgmentFaulty judgment
• Lapses in attention and vigilanceLapses in attention and vigilance
• Impaired decision making and logical reasoningImpaired decision making and logical reasoning
• Increased risk taking Increased risk taking
FatigueFatigue
Effect of fatigue/sleep deprivationEffect of fatigue/sleep deprivation
• Slowed reaction timeSlowed reaction time
• Susceptibility to illnessSusceptibility to illness
• Increased sensitivity to painIncreased sensitivity to pain
All result in reduction in Performance & SafetyAll result in reduction in Performance & Safety
Three Most Common Sleep Disorders Are…Three Most Common Sleep Disorders Are…
1)1) InsomniaInsomnia
10 – 15% of adults suffer from chronic and severe 10 – 15% of adults suffer from chronic and severe insomniainsomnia
2) The Parasomnias2) The Parasomnias
Up to 10% of the adult populationUp to 10% of the adult population
3) Snoring and Obstructive Sleep Apnoea (OSA)3) Snoring and Obstructive Sleep Apnoea (OSA)Snoring – up to 60% adults snore regularlySnoring – up to 60% adults snore regularlyOSA – 9% of males, 4% females over 40OSA – 9% of males, 4% females over 40
• InsomniaInsomnia
Medical problems associated withMedical problems associated with
InsomniaInsomnia
•Heart Disease x 2.27Heart Disease x 2.27•Cancer x 2.17Cancer x 2.17•Hypertension x 3.18Hypertension x 3.18•Diabetes x 1.8Diabetes x 1.8•Gastrointestinal x 3.33Gastrointestinal x 3.33
Sleep HygieneSleep Hygiene
• To Provide information about lifestyle, and environment that might interfere with sleep, or promote better sleep.
• These strategies are important as a baseline, and should be combined with the other treatments.
• As a sole therapy, it is not effective for the more severe insomnia, but should be addressed in therapy.
Stimulus ControlStimulus Controlfor those with insomniafor those with insomnia
Stimulus Control Stimulus Control is based on classical is based on classical
conditioned responseconditioned response to certain stimuli.to certain stimuli.
This involves This involves strengtheningstrengthening the relationship the relationship
between between bedbed and and sleepsleep, ,
and and breakingbreaking the negative relationship the negative relationship
between between bedbed and and anxietyanxiety and and wakefulnesswakefulness
Important and Effective Important and Effective
Bed Restriction TherapyBed Restriction Therapyfor those with insomniafor those with insomnia
Sleep restriction Sleep restriction therapy is designed to improve therapy is designed to improve
sleep consolidation sleep consolidation and and sleep efficiencysleep efficiency..
This is achieved by initially This is achieved by initially increasingincreasing the the
homeostatic drive homeostatic drive to sleep.to sleep.
Sleep efficiency is improved.Sleep efficiency is improved.
Time in bed can then be increasedTime in bed can then be increased
The most difficult, but the most effectiveThe most difficult, but the most effective
The ParasomniasThe Parasomnias
In Non-REMIn Non-REM
In REMIn REM
Sleep Related Movement DisordersSleep Related Movement Disorders
Restless Leg SyndromeRestless Leg Syndrome
Periodic Limb movements in SleepPeriodic Limb movements in Sleep
The ParasomniasThe Parasomnias
In Non-REM In Non-REM
Sleep WalkingSleep Walking
Night terrors Night terrors
Sleep Related Eating Disorder Sleep Related Eating Disorder
Sexsomnia Sexsomnia
REM related sleep disordersREM related sleep disorders
NightmareNightmare
REM-Sleep Behaviour DisorderREM-Sleep Behaviour Disorder
Sleep Related Movement Disorders:Sleep Related Movement Disorders:Restless Leg syndromeRestless Leg syndrome
Essential featuresEssential features
- Unpleasant sensation in the legs requiring the urge to move- Unpleasant sensation in the legs requiring the urge to move
- Urge to move is worse at times of inactivity- Urge to move is worse at times of inactivity
- Unpleasant sensation is partially or completely relieved by movement- Unpleasant sensation is partially or completely relieved by movement
- Unpleasant sensation is worse in the evening or at night.- Unpleasant sensation is worse in the evening or at night.
Sleep Related Movement Disorders:Sleep Related Movement Disorders:
Periodic Limb Movements in Sleep Periodic Limb Movements in Sleep
- Daytime sleepiness- Daytime sleepiness
- Restlessness during sleep- Restlessness during sleep
- Nighttime arousals- Nighttime arousals
- Observed limb jerking at night. - Observed limb jerking at night.
Typically extension of the big toe,Typically extension of the big toe,
dorsiflexion of the ankle,dorsiflexion of the ankle,
occasional flexions of the knee, and hipoccasional flexions of the knee, and hip
•
•
• •
The Agony or the EcstasyThe Agony or the Ecstasy
Familiar?
Snoring Related ComplaintsSnoring Related Complaints
Drives wife from bedroomGirlfriend won’t marry meShakes entire houseAsk me to leave movies and churchHas had to leave boat so friends could sleepFall asleep at traffic lights waiting for red
light to change
Consequences of Sleep ApnoeaConsequences of Sleep Apnoea
1. Daytime fatigue, especially sleepiness
2. Bed partner sleep disturbance
3. Cardiovascular complications
Consequences of Sleep ApnoeaConsequences of Sleep Apnoea
Medical consequences :-
Hypertension
Insulin Resistance
Cardiac Arrhythmia
Heart Attack
Stroke
Nocturnal GORD
Nocturia
Depression
Risk Factors for Sleep ApnoeaRisk Factors for Sleep Apnoea(Not exclusive)
Male
Increasing age
Body Mass Index > 30
Neck Circumference > 42cm ( 17ins)
Alcohol ( > 2 units)
Smoking
Post Menopausal Women
Sleeping Pills
Laugh and the world laughs with you…
…snore and you sleep alone.
Thank YouThank You
Dr Alex BartleDr Alex Bartle
SLEEP WELL CLINICSLEEP WELL CLINICChristchurch, Auckland, WellingtonChristchurch, Auckland, Wellington
Nelson, Tauranga, WhangareiNelson, Tauranga, Whangarei
www.sleepwellclinic.co.nzwww.sleepwellclinic.co.nz