Peter Cistulli | MBBS, PhD, MBA, FRACPHead, Discipline of Sleep Medicine

University of Sydney Medical SchoolRoyal North Shore Hospital

Royal North Shore Hospital

The Importance of Sleep to a Healthy Workplace

Sleep is NOT a luxury

Workplace Implications

SleepLeadership

Resilience

Productivity

Creativity

Health

Morality

©Dr Peter Cistulli

Outline

› The Changing World and Work-Life Balance

› Economic Cost of Unhealthy Sleep

› The Science of Sleep

› Sleep Disorders

› Getting a Better Night’s Sleep

©Dr Peter Cistulli

Triumvirate of Life

Sleep

NutritionExercise

©Dr Peter Cistulli

The Origins of the 24 Hour Society

Today’s 24 Hour Society

A hyper-connected world

Productivity gone mad!

A non-stop world

LIFE WORK

SLEEP

Work – Life Balance: The Old Days

©Dr Peter Cistulli

LIFE WORK

SLEEP

Work – Life Balance: The New Norm

©Dr Peter Cistulli

Beware the Vicious Cycle

work

©Dr Peter Cistulli

Economic Cost of Sleep Disorders

The Cost of Unhealthy Sleep

What is Sleep?

› Sleep is the body’s rest cycle

› Is a reversible behavioural state of perceptual disengagement

› Generally an unresponsiveness to the environment

©Dr Peter Cistulli

Cycles of Sleep

The time of night when you sleep makes a significant difference in terms of the structure and quality of your sleep.

Wake - Sleep Brain Chemicals

Wake Sleep

Claustrat B, et al. Sleep Med Rev. 2005.

SCN Pineal Gland Melatonin

The Human (Circadian) Clock

› Around 7.5-8 hours- Enough to be safe on the road, at home and at work

› <6.5 hrs U >8.5 hrs associated with reduced performance and ill-health

› Importance of genetics

How Much Sleep Do We Need?

©Dr Peter Cistulli

Effects of Sleep Deprivation

- Mental Health issues

Dangers of Sleeping on the Job…

Work Intruding on Sleep Time…

Sleep Disorders: The Big Four

› Insomnia

› Snoring and sleep apnoea

› Restless Legs Syndrome

› Shift work disorder

Insomnia › Repeated persistent difficulty with- Sleep initiation

- Sleep duration/consolidation

- Or quality

› Despite adequate opportunity to sleep- Associated daytime impairment

› Very common› Insomnia is distressing

What is Insomnia?

©Dr Peter Cistulli

Consequences of Insomnia

› Depression

› Irritability

› Motor Vehicle Accidents – inattention more than ‘fall asleep accidents’

› Medical Consequences – Hypertension in insomniacs with <5hrs sleep (Sleep 2009)

› Absenteeism & loss of work productivity

› Alcohol abuse

©Dr Peter Cistulli

Insomnia: Treatment Options

› Sleep hygiene

› Cognitive Behaviour Therapy (CBT)

› Drug therapy- Prescription

- Over the counter

- Self medication (eg. alcohol)

©Dr Peter Cistulli

Snoring and Obstructive Sleep Apnoea (OSA)

Prevalence of Snoring and OSA

› Habitual snoring- 24% men, 14% women- 30-60% men > 45 yrs- 10-20% of children

› Obstructive Sleep Apnoea (OSA)- 17% of adults- Almost 6% of adults have

moderate to severe OSA

©Dr Peter Cistulli

Consequences of OSA

› Daytime sleepiness› Memory & concentration

disturbances› Motor vehicle accidents› High blood pressure› Heart attack› Stroke› Diabetes

©Dr Peter Cistulli

Diagnosis and Treatment of Snoring and OSA

CPAP Oral device

Weight loss

Surgery

Restless Legs Syndrome

› 5-10% population› Familial› Secondary causes› Treatment with medications (dopamine)

Shift Work Disorder

› Sleep in night-shift workers is usually shortened by 1 to 4 hours compared to daytime workers

› Symptoms:− Difficulties falling asleep or

maintaining sleep− Unrefreshing sleep− Sleepiness at work

› Consequences of chronic partial sleep deprivation− Can impair social and cognitive

function− Sleepiness and safety hazards

©Dr Peter Cistulli

Shift Work Disorder Treatment

› Goal: Optimise circadian alignment, sleep quality, and performance and safety at work

› Combined approach:

− Bright light exposure (continuous or intermittent) beginning early during the night shift and terminating 2 h before the end of the shift to improve adaptation of circadian rhythm

− Avoiding bright light by wearing dark glasses during the morning commute

− Manage insomnia

− Manage sleepiness

©Dr Peter Cistulli

Getting a Better Night’s Sleep….

› Sleep awareness

› Clean up your act – sleep hygiene

› Understand your body clock

› Seek help for sleep disorders

©Dr Peter Cistulli

› Avoid stimulants at night (eg. Caffeine, exercise)› Go to bed later, get up earlier

- Increase your sleep debt› Go to bed only when comfortable› Use bed only for sleep (…and sex)

- Re-establish the link between bed and sleep- Make bed a safe place of sleeping

› Get out of bed if unable to sleep within around quarter of an hour

› Go back to bed when you feel less tense› Avoid bright light in the lead up to bed (ie. no

electronic media)

Sleep “Hygiene”

©Dr Peter Cistulli

The Sleep Tech Revolution

Self EducationTreatment Adherence

Web based therapy

More Information…..www.sleephealthfoundation.org.au

Happy Body At Work Program