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Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
Sleep Presentation
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Sleep Presentation

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  • 1. Sleep Presentation by Mendy Peterson PA-C April 23rd 2009
  • 2. Objectives: What is Normal Sleep? -circadian rhythm and EEG's -brain and hormones -sex and age patterns Common Sleep Disorders: -parasomnias and insomnia's -sleep apnea & obesity -sleep lab studies Consequences of Abnormal Sleep: -Health -Cost and Employers -Car Accidents -2007 Sleep in America Poll How to Change! -Day & Bedtime routines -Medications & Alternative Meds -Naps
  • 3. What is Normal Sleep?
  • 4. Cortisol is a hormone released by the adrenal gland that sits on top of the kidney.
  • 5. That was quot;Cortisolquot; NOT quot;Caffeine!quot;
  • 6. Theta Waves Sleep Spindles/K Complex Delta Waves More Delta Waves Dreams!
  • 7. Which is better- REM vs Non-REM?
  • 8. Hormones and Sleep TSH - Thyroid Cortisol - Adrenal Glands Prolactin - Pituitary/Breast milk Growth Hormone Melatonin Serotonin - Mood stabilizer Epinephrine - quot;I am speed!quot; Estrogen - ahhhh menopause! And..... Many Many more!
  • 9. Men vs. Women Hard Sleep Light Sleep How Hard? 6 hours 8 hours + How Long? Better Worse With Mate? More Less Sleep Apnea? More Less Sleep Disorders? Car Accidents More Less
  • 10. Sleep Questionnair e
  • 11. 0 = Would never doze 1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = High chance of dozing Sitting and Reading _____ Watching TV _____ Sitting inactive in a public place (i.e. theatre) _____ As a car passenger for an hour without a break _____ Lying down to rest in the afternoon _____ Sitting and talking to someone _____ Sitting quietly after lunch without alcohol _____ In a car, while stopping for a few minutes in traffic _____ A score of greater than 10 is a definite cause for concern as it indicates significant excessive daytime sleepiness. Consider completing full questionnaire and submit to your doctor!
  • 12. Sleep Disorders
  • 13. SHORTENED SLEEP LATENCY Alcohol and drug induced sleep Narcolepsy Sleep apnea Sleep deprivation
  • 14. Prolonged Sleep Latency Delayed sleep phase syndrome Inadequate sleep hygiene Psychiatric disorders-Acute schizophrenia, Major depression, and Mania Restless leg syndrome
  • 15. Causes of shortened or sleep onset REM sleep Alcohol, sedative and hypnotics Depression Narcolepsy Sleep apnea Sleep deprivation
  • 16. Sleep disorders in aged Leg movement disorders REM behavior disorder Sleep apnea syndrome Medication induced sleep disorders Medical disorders especially cardiovascular disturbances and pain Dementia Neurological disorders Depression
  • 17. Dyssomnias-characteristics Patients may complain of difficulty getting to sleep or staying asleep, intermittent wakefulness during the night, early morning awakening, or combinations of any of these. Transient episodes are usually of little significance. Stress, caffeine, physical discomfort, daytime napping, and early bedtimes are common factors
  • 18. Dyssomnias-causes There are over 30 recognized kinds of Dyssomnias. Major groups of Dyssomnias include: Intrinsic sleep disorders - 12 disorders recognized, including hypersomnia, narcolepsy, periodic limb movement disorder, restless legs syndrome, sleep apnea. Extrinsic sleep disorders - 13 disorders recognized, including alcohol-dependent sleep disorder, food allergy insomnia, inadequate sleep routine. Circadian rhythm sleep disorders - 6 disorders recognized, including advanced sleep phase syndrome, delayed sleep phase syndrome, jetlag, shift work sleep disorder
  • 19. Dyssomnias-conditions-Narcolepsy Narcolepsy is a neurological condition most characterized by Excessive Daytime Sleepiness (EDS). A narcoleptic will most likely experience disturbed nocturnal sleep, confused with insomnia, and disorder of REM or rapid eye movement sleep. The main characteristic of narcolepsy is overwhelming excessive daytime sleepiness (EDS), even after adequate nighttime sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places Four other classic symptoms of narcolepsy, which may not occur in all patients, are cataplexy, sleep paralysis, hypnogogic hallucinations, and automatic behavior.
  • 20. Periodic Limb Movements Periodic Limb Movement Disorder (PLMD), also called nocturnal myoclonus, is a sleep disorder where the patient moves involuntarily during sleep It is related to restless leg syndrome (RLS) in that 80% of people with RLS also have PLMD. However, most people with PLMD do not experience RLS Nocturnal myoclonus is treated by medications aimed at reducing or eliminating the leg jerks or the arousals. Non-ergot derived dopaminergic drugs (pramipexole and ropinirole) are preferred. Other dopaminergic agents such as co-careldopa, co-beneldopa, pergolide, or lisuride may also be us These medications are also successful for the treatment of RLS restless leg syndrome.
  • 21. Restless Leg Syndrome-types Primary RLS is considered idiopathic, or with no known cause. Secondary RLS often had a sudden onset and may be daily from the very beginning The most commonly associated medical condition is iron deficiency (medicine), which accounts for just over 20% of all cases of RLS. The conditions include: pregnancy, varicose vein or venous reflux , folate deficiency, uremia, diabetes, thyroid problems, peripheral neuropathy, Parkinson's disease and certain auto-immune disorders such as Sjögren's syndrome, Celiac Disease, and rheumatoid arthritis. Treatment of the underlying condition often eliminates the RLS.
  • 22. Parasomnias-what, why and which ? A sleep disorder is a physical and psychological condition or disturbance of sleep and wakefulness caused by abnormalities that occur during sleep or by abnormalities of specific sleep mechanisms Although the sleep disorder exists during sleep, recognizable symptoms manifest themselves during the day Accurate diagnosis requires a polysomnogram, widely known as a quot;sleep test.“
  • 23. Parasomnias-classifications A. Arousal-Sleep terrors, Sleepwalking B. Sleep-Wake Transition-Rhythmic movement disorders C. Parasomnias with REM sleep-Nightmares, Sleep paralysis, and REM sleep Behavior disorders D. Other Parasomnias- Bruxism and Enuresis
  • 24. Parasomnias-Bruxism Sleep related, stereotyped, forceful teeth grinding or clenching Is also associated with dementias, mental retardation and Parkinson’s disease
  • 25. Insomnia-causes Medical and neurological conditions Drug and alcohol abuse Psychiatric disorders Patients older than 65 years of age
  • 26. Recording of Polysomnography Simultaneous recordings of EEG, EOG, EMG, EKG, vital signs and breathing
  • 27. What answers to expect from Polysomnography ? Polysomnography is a comprehensive recording of the biophysiological changes that occur during the sleep Polysomnography is usually performed during the night when patient sleeps Usually performed with CPAP titration if needed.
  • 28. Consequences of Abnormal Sleep - Health Effects - Cost to Employers - Car Accidents
  • 29. When do most sleep deprivation car accidents occur? In the early to mid afternoon and in the very early morning hours. These are the times when everyone is least alert.
  • 30. Women & Sleep: Key Findings Overall
  • 31. 2007 Poll Roadmap The 2007 Sleep in America Poll findings: Sleep among women overall The effect of women’s biology on sleep The effect of women’s lifestyle on sleep
  • 32. Women Are Not Getting the Sleep They Need 60% say they only get a good night’s sleep a few nights per week or less 60 %
  • 33. Why Are Women Not Getting the Sleep They Need? 67% experience sleep problems at least a few nights each week, with 46% experiencing sleep problems every night 67 %
  • 34. Why Are Women Not Getting the Sleep They Need? Lifestyle impacts sleep Working mothers (72%) and single working women (68%) are more likely to experience sleep problems like insomnia Other factors that wake women up Noise (39%) Giving care to children (20%) Pets (17%)
  • 35. Why Are Women Not Getting the Sleep They Need? Women who allow kids (9%) or pets (14%) to share their bed have the most disturbed sleep 47% of women say they have no one helping them care for children at night
  • 36. Consequences of Poor Sleep Poor sleep and poor mood are intertwined Poor sleep can worsen mood Approximately 80% of women report being stressed out, anxious or worried 55% state they have been unhappy, sad, and depressed in the last month Mood can in turn worsen sleep and lead to heightened depression and anxiety
  • 37. How Women Cope with Poor Sleep… 80% accept daytime sleepiness and keep going 65% drink caffeinated beverages Of those, 37% drink 3 or more caffeinated beverages a day
  • 38. Although Consistently Tired, Women Do Not Go to Bed Earlier In the hour prior to bed they :
  • 39. How Women Cope with Poor Sleep… Anti-depressants prescribed by a doctor 12% Sleep medication prescribed by a doctor 8% Combination sleep aid and pain reliever 9% OTC or store-bought sleep aids 6% Alternative therapy or herbal supplements 2%
  • 40. Compromise: Choices Women Make When women are tired or run out of time during the day… Healthy lifestyle activities are sacrificed Forego sleep (52%) and exercise (48%) Reduce time spent with family and friends (39%) Stop healthy eating (37%) Don’t participate in sexual activity (33%) Work remains a priority Only 20% of women put work on the “back burner”
  • 41. Sleep & Women’s Biology Women experience more sleep problems than men A woman’s overall health affects her ability to sleep well As women progress through different life stages, changing biology affects their ability to get a good night’s sleep
  • 42. Sleep and Health Poor health is linked to sleep problems Of women who are in fair to poor health: 66% experience a symptom of a sleep disorder at least a few nights per week 40% diagnosed with a sleep disorder 46% experience daytime sleepiness a few days per week 26% have missed work in the past month 54% use a sleep aid a few nights per week
  • 43. Different Life Stages Respondents were asked about the quality and quantity of their sleep during 5 reproductive stages Women of Childbearing Age Pregnancy Post Partum Perimenopausal Postmenopausal
  • 44. Women of Childbearing Age 67% experience insomnia a few nights per week 34% report experiencing a sleep disorder such as snoring, sleep apnea or RLS 33% say their sleep is disturbed during the week of their menstrual cycle 16% have missed work during the past month due to a sleep problem
  • 45. Pregnant Women 30% say they rarely or never get a good night’s sleep 84% have insomnia at least a few nights each week 40% report sleep disorders such as snoring, sleep apnea or RLS 54% nap at least twice per week
  • 46. Post Partum Women This is the first national sleep survey of post partum women. Post partum women have insomnia at the same rate as pregnant women (84%) 42% say they rarely/never get a good night’s sleep, more than any other group 47% report no one helping with kids 20% have driven drowsy with kids 19% experience post partum blues/depression
  • 47. Perimenopausal Women 59% have insomnia a few nights per week 43% report symptoms of a sleep disorder such as snoring, sleep apnea or RLS Noise (36%) and co-sleeping with pets (20%) are the most common nighttime disturbances 20% experience night sweats and hot flashes
  • 48. Postmenopausal Women Have the highest incidence of: Limited time in bed - less than 6 hours (14%) Sleep disorders such as snoring or sleep apnea (42%) RLS (22%) Sleep aid use (41%) Obesity (30%)
  • 49. Sleep & A Woman’s Lifestyle
  • 50. Lifestyle and Sleep Sleep is greatly impacted by lifestyle 2007 NSF Sleep in America poll examined sleep among 6 segments of women Working, Single Women DINKs and Empty Nesters Stay-at-Home Moms Part-time Working Moms Briefcases with Backpacks 50-somethings
  • 51. Working, Single Women Spend the least time in bed, generally less than 6 hours 54% wake up un-refreshed a few days each week 70% accept this and keep going 47% consume more than 3 cups/cans of caffeinated beverages per day Nearly 30% use the weekends to “catch up” on sleep
  • 52. DINKs & Empty Nesters Working married/partnered women with no children or grown children get better sleep than most groups - despite being in bed less than 7 hours per night Low incidence of sleep problems (15%) Yet, healthy lifestyle choices are still compromised because women are tired or run out of time 46% report having no time for sleep 47% sacrifice exercise 38% don’t participate in sexual activity
  • 53. Stay-at-Home Moms 74% rarely get a good night’s sleep Despite this, 61% say they spend over 8 hours in bed each night In the hour before bed, 71% complete household chores and activities with kids 57% nap at least once per week 43% curtail leisure activities 39% forego sexual activity
  • 54. Part-time Working Moms Report getting the best sleep of all the groups 50% say they are in bed for over 8 hours per night 68% accept the day’s challenges and keep going Napping is frequent; 60% take a nap at least once per week
  • 55. Briefcases with Backpacks Married/partnered women with school-aged kids, who work full time Spend less than 6 hours in bed per night 72% have insomnia 70% accept sleepiness and keep going 56% use caffeine Highest rate of drowsy driving (35%) Lifestyle compromises are high 60% give up sleep and exercise 52% do not socialize regularly with family and friends 44% do not have time for sex
  • 56. 50-somethings Are not employed, no children at home Have highest frequency of sleep disorders Highest sleep aid usage (41%) 32% say they get a good night’s sleep only a few nights per month Spend over 8 hours in bed per night and frequently nap
  • 57. NSF 2007 Poll Overview American women are… Not sleeping well which affects all aspects of their life- work, relationships, sex? Struggling to “do it all” and as a result sacrifice sleep Using many coping strategies to sustain the pace of daily life Impacted by biological and lifestyle factors affecting their sleep
  • 58. Insulin resistance Increased blood sugar Elevated Cortisol levels Systemic inflammation Disrupted Immunity Impaired thyroid function Disruption of your body clock or body rhythm Premature Aging
  • 59. Why aren’t we sleeping well? Temperature fluctuations, tossing & turning Mental Stress Discomfort & physical stress Environment Diet & lack of regular exercise
  • 60. Time for Change! How do we help ourselves?
  • 61. What Women Can Do? Make healthy sleep a priority! Make time to get 7-9 hours of sleep Create a relaxing and quiet environment Exercise regularly (not less than 3 hours before bed time) and eat healthy Avoid caffeine and alcohol before bed If you have a new infant, arrange for help Set a sleep schedule Try a warm bath before bed
  • 62. Natural Sleep Solutions: Sleep Masks/CPAP Ear Plugs Acupuncture Massage Meditation/Sleep Therapy Melatonin Prescription Medications: Rozarem- melatonin derivative Ambien/Lunesta- Hallucinogenics Provigil- for Narcolepsy Others- GABA receptors- Neurontin/Lyrica Anti-depressants Hormones? (Estrogen, etc.)
  • 63. Controversial Topics?? Work Less? Less Co-Sleeping? quot;Cry it Outquot; Sleep Methods?
  • 64. What about naps?
  • 65. Questions?

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