Sleep and health. Why we need sleep. How can we sleep better.

1. SLEEP
How does it keep us healthy?
By
Dr M. Sen

2. Do we need sleep?
 Sleep is often one of the first things to go when
people feel pressed for time.
 Many view sleep as a luxury and think that the
benefits of limiting the hours they spend asleep
outweigh the costs.
 We often overlook the potential long-term health
consequences of insufficient sleep, and the impact
that health problems can ultimately have on one's
time and productivity.

3. Yes, we do.
Many experts
suggest that
quality sleep is
as important to
your health and
well-being as
good nutrition
and exercise

4. Sleep Physiology

5. Stages of Sleep
 The human body goes through stages of
sleep when we lay down to rest, and
interference with the sleep cycle can cause
tiredness and irritability the following day.
 Science has discovered two distinct types
of sleep, known as
 1. rapid eye movement (REM) sleep and
 2. non-REM sleep.

6. Sleep Stages
 Sleep has 5 stages:
 Stage 1: non-REM sleep.
 This sleep occurs in the first moments after you
have laid your head down on your pillow and
closed your eyes.
 The eyes move slowly and muscle movement
ceases.
 In this stage, the sleeper can be easily awakened
by noise or other disturbances as she drifts in and
out of sleep.

7.  Stage 2: non-REM sleep.
 In this stage of sleep, the person is actually
asleep and the sleeper is not aware of her
surroundings.
 Body temperature drops, breathing and
heart rate are regular, and eye movements
decrease significantly or are non-existent.
 Brain waves slow down, though there may
be bursts of activity.

8.  Stage 3: non-REM sleep.
 This is deep sleep, characterized by even
slower brain waves and less sporadic
bursts of brain wave activity.
 Breathing slows and muscles relax.
 Sleepers are hard to awaken during this
stage.
 Children sometimes wet the bed during
this stage of sleep.

9.  Stage 4: non-REM sleep.
 This is the deepest sleep and is characterized
by very slow brain waves and no sporadic
bursts of brain wave activity.
 As with Stage 3 non-REM sleep, sleepers are
hard to wake up.
 Scientists believe that tissue repair takes
place during this stage of sleep.
 Also, hormones will be released to assist with
growth and development.

10. Once the sleeper reaches stage four
(about an hour after sleep begins) they
then travel back up through stages
three, two and one.
When stage one is reached for the
second time, REM sleep begins and the
sleeper engages in about ten minutes
of dreaming.

11. REM Sleep
Stage 5: REM sleep.
 The REM stage is the sleep during which we
dream.
 It is characterized by rapid eye movements
even though the eyes are closed.
 Breathing is rapid, irregular, and shallow.

12.  The heart rate and blood pressure increase.
 Arms and leg muscles experience a type of
paralysis that keeps people from acting out their
dreams. But some may talk or walk during REM
sleep.
 The process of dreaming is not well understood
but the process does stimulate the parts of the
brain used for learning and memory.

13.  Some studies suggest that dreams are a way for the
brain to sort and store information gathered
throughout the day, rather like a filing cabinet.
 This last cycle of the stages of sleep occurs about an
hour to 90 minutes into the sleep session.
 Sleep cycles through all of the stages until the
sleeper awakes. However, the length of time of each
cycle changes throughout the night.

14. Lack of REM sleep appears to affect our
ability to concentrate and remember.
When allowed to sleep uninterrupted,
subjects experience REM rebound. That
is, they spend twice as much time in
REM sleep as normal to make up for
the REM sleep lost.
 This indicates that REM sleep is vital for
our survival.

15. Sleep hormones
Our two main sleep brain hormones are:
• Serotonin, which is produced during the day and
• Melatonin, which is produced at night.
 If you are happy during the day and sleep
soundly at night, then your brain hormones are
well balanced.

16. Serotonin
Serotonin is secreted in the central nervous system.
 It has multiple tasks of regulating moods, appetite,
sleep, and more.
 The lack of Serotonin causes many negative
symptoms to appear such as anxiety, depression,
insomnia and irritability.
 Serotonin is the main “happy hormone” in our
brain, that is necessary for good brain health.
 If we sleep well, serotonin levels stay normal.

17. MELATONIN
Melatonin is secreted by the Pineal Gland, just
below the brain.
It has multiple purposes, being associated primarily
with:
1. Synchronization of the biological clock and
2.As an antioxidant.

18. Melatonin is produced from Serotonin during low
light conditions, and is produced naturally when
darkness falls.
• Melatonin acts as an antioxidant.
• It increases lifespan by 20%
• It increases Killer T cells of the immune system.

19. Brain Waves
 1. Beta waves: frequency=14-30 cycles/sec.
 Typical level of daily mental activity, alert, active.
 It is also the level of activity associated with
tension or stress.
 2. Alpha waves: frequency = 8-13 cycles/sec.
 Relaxed, passive attention, reverie, often
considered the goal of relaxation exercises.
 Helps to reduce stress.
 Brain waves in REM sleep.

20.  Theta waves: frequency = 4-7 cycles/ sec.
 Normally considered to be drowsy, or half-asleep.
 This level is where there is still the experience of
images and streams of thoughts. Stage 1 and 2 of
non-REM sleep.
 Delta waves: Frequency = 0.5-3.5 cycles /sec.
 Considered to be unconscious, dreamless, deep
sleep (Stage 3 and 4).
 Also the wave in coma and under anaesthesia.

21.  For good health we need about 6 hours of
Delta Wave sleep in 24 hours, and 1 hour of
REM sleep.
 REM sleep usually occurs 2 to 6 times a night,
and lasts 3 t0 10 minutes.
 REM sleep is necessary for brain processing
activity.

22. Insomnia

23. Insomnia is dangerous.
 17 hours of continuous sleeplessness leads to a
decrease in performance that is equivalent to a
blood alcohol level of two glasses of wine(0.05%).
 Sleep loss may increase the risk of obesity because
chemicals and hormones that play a key role in
controlling appetite and weight gain are released
during sleep.

24. How Has Sleep Changed Historically?
 Estimated 8-9 hrs in early
20th Century.
 7-8 hrs mid 1980s-2002
 College Students:
 1980s reported 7-7.5 hrs
 2002 reported 6-6.9 hrs
 Going to bed later is the culprit
 Bedtime is 1-2 hrs later
than it was 25 yrs ago

25. The problem with being tired…
Sleep deprivation can lead to:
 chronic tiredness
 mood changes
 frustration
 difficulty controlling emotions
 inability to think abstractly
 And all these release the stress
hormones in the body.

26. How much sleep?
 In order to be at your peak
performance you need at least
8 hours of sleep.
 Not everyone needs the same
amount of sleep (Natural short
and long sleepers).
BUT sleeping less than 6.5 or
more than 9 hours is
associated
with greater mortality & risk of
disease.

27. Sleep Deprivation and Disease
Risk

28. Sleep deprivation has a profound impact on multiple
disease states. For example, if you sleep less than 6
hours, epidemiologic studies show the following:
1. Stroke is increased by a factor of 4 times.
2. Obesity is increased by an increase in ghrelin, which
is a hunger hormone.
3. Diabetes is increased because sleep deprivation
increases insulin resistance.
4. An increased risk for colon, gastric, breast, bladder,
prostate, and salivary cancers; and at least 1
epidemiologic study shows an association between
sleep deprivation (or lack of sleep) and an increase
in the likelihood of precancerous (adenomatous)
lesions.

29. 5. Memory loss is accelerated. Epidemiologic studies
show that there is not only permanent cognitive loss
but also evidence of early brain deterioration.
6. Osteoporosis is increased, at least in an animal
model, with changes in bone mineral density. Even
changes in bone marrow are evident within 3 months
of a study in a rat model.
7. Cardiac disease is increased. There is a 48%
increase in early cardiac death, as well as increased
cardiac-related mortality.
8. A 4-fold overall increase in mortality.

30. 
 Short sleep duration is
associated with high levels
of ghrelin and obesity;
 Scientists have uncovered
an inverse relationship
between the hours of
sleep and blood plasma
concentrations of ghrelin;
Ghrelin, the
stomach hormone.

31.  Loss of sleep increases our body's production of the
hormone Ghrelin, which stimulates hunger.
 Lack of sleep also decreases the levels of the
hormone Leptin, which signals our brain when our
body doesn't require any more food.
 The result of this imbalance can make one feel
hungry all the time and encourages over-eating. At
the same time, it slows the rate at which our body
burns calories.

32.  There is growing evidence of a
connection between sleep loss caused by
obstructive sleep apnea and an increased
risk of cardiovascular diseases, including
hypertension, stroke, coronary heart
disease, and irregular heartbeat.
 OSA is more common in the obese.

33. Time for a change
Must Sleep!!

34. Benefits!
1. Sleep Keeps our Heart Healthy
 Heart attacks and strokes are more common during
the early morning hours. This fact may be explained
by the way sleep interacts with clotting of blood.
 Our heart will be healthier if we get between 7 and 9
hours of sleep each night.

35. 2. Sleep Prevents Cancer
 People working the late shift have a higher risk for
breast and colon cancer.
 Researchers believe this link is caused by differing
levels of melatonin in people who are exposed to
light at night.

36.  Light exposure reduces the level of
melatonin, a hormone that both makes us
sleepy and acts as an antioxidant.
 Melatonin appears to suppress the growth of
tumours. (So closing your eyes may help
reduce cancer risk!)

37. 3. Sleep Reduces Stress
 When our body is sleep deficient, it goes into a state
of stress.
 The body's functions are put on high alert which
causes an increase in blood pressure and a production
of stress hormones.
 Higher blood pressure increases risk for heart attacks
and strokes.
 The stress hormones also, unfortunately, make it
harder for us to sleep. (This is where exercise helps).

38. 4. Sleep Reduces Inflammation
The increase in stress raises the level of
inflammation ( by increasing free radical
formation), also creating more risk for:
 heart-related conditions, as well as
 cancer and diabetes.
 Inflammation is thought to be one of the
causes of the deterioration of our body as we
age.

39. 5. Sleep Makes us More Alert
 A good night's sleep makes us feel energized and
alert the next day.
 When we wake up feeling refreshed, we use the
day better.
 You'll also sleep better the next night and
increase your daily energy level.

40. 6. Sleep Bolsters our Memory
 Researchers do not fully understand why we
sleep and dream, but a process called
memory consolidation occurs during sleep.
 While our body may be resting, our brain is
busy processing our day, making connections
between events, sensory input, feelings and
memories.

41.  Sleep helps the brain commit new information
to memory through the process of
neuroplasticity (making new neuronal
connections).
 In studies, people who’d slept after learning a
task did better on tests later.
 Sleep also enables the brain to recover after
emotional stress and this helps us deal better
with traumatic situations later.

42. 7. Sleep May Help You Lose Weight
We now know that people who sleep less
than seven hours per night are more likely to
be overweight or obese.
 So if you are interested in controlling or losing
weight, don't forget to pay attention to
getting a good night's sleep!

43.  Restricting sleep to 4 hours a night for 5
consecutive nights led to more weight gain for
sleep-restricted participants than for control
participants, according to results from a large,
diverse, in-laboratory assessing sleep's effect on
weight, calorie intake, and meal timing.
 Study participants were all nonsmokers whose body
mass index (BMI) ranged from 19 to 30 kg/m2 and
who did not experience any irregular sleep/wake
routines during the 60 days before the study.
 Andrea M. Spaeth, MA, et al, Department of Psychology,
School of Arts and Sciences, University of Pennsylvania,
Philadelphia, Sleep. 2013;36:981-990.

44. 8. Sleep May Reduce our
Risk for Depression
 Sleep impacts many of the chemicals in our
brain, including Serotonin (which also
makes Melatonin).
 People with a deficiency in serotonin are
more likely to suffer from depression.
We can help to prevent depression by
making sure to get the right amount of
sleep, between 7 and 8 hours each night.

45. 9. Sleep Helps the Body Make Repairs
 Sleep is a time for our body to repair
damage caused by stress, ultraviolet rays
and other harmful exposures.
 Our cells produce more protein while we
are sleeping.
 These protein molecules form the building
blocks for cells, allowing them to repair
damage.

46. 10. Sleep improves our Immunity
 Melatonin secreted
during sleep acts as an
antioxidant by itself.
 It also stimulates the
immune cells
(Lymphoctes) to act.
 So, a good night’s rest
helps you heal and fight
infections better.

47. So, a Good Night’s Sleep can reduce:
 Heart disease
 High blood pressure
 Obesity
 Diabetes
 All-cause mortality And can improve:
- Life span.
- Memory
- Energy and
- Happiness

48. How to Establish Good Sleeping Habits
SLEEP HYGIENE

49.  Society as a whole doesn't put enough
emphasis on the importance of a good
night's sleep. Today's hectic, high-tech
lifestyle is not geared towards allowing
people to get enough healthy, restful
sleep.
 Grueling 60-hour work weeks, 24 hour
shopping and exercise facilities, and
continual access to television and the
internet make getting ample sleep a
challenge.

50. How to Determine Your Sleep Needs
 You can identify how much sleep you need
each night by thinking about how you feel
when you wake up after a specified number of
hours asleep.
 You know you have benefited from the right
amount of sleep when you can easily awaken
feeling alert and ready to get out of bed.
 Duration and quality of sleep are directly
related to the quality of our sleep hygiene.

51. Acquiring Better Sleep Habits
 Set a sleep schedule and stick to it.
Aim to go to bed and get up at the same
time each day. Yes, even on weekends. This
keeps your internal body clock on track and
encourages naturally restorative sleep.
 Create a calming bedtime routine.
Practicing relaxation techniques like
meditation or breathing exercises can also
be helpful.

52.  Protect your sleep environment
Turn your bedroom into your own personal
sleep sanctuary. Use your bedroom for sleep
(and lovemaking) only... no work, hobbies,
TV, or heated arguments.
 If you can't sleep, get up.
Instead of tossing and turning for hours, if
you're still wide awake after 30 minutes of
being in bed, get up. Leave your bedroom
and do something quiet and relaxing

53.  Avoid the 'sleep-stealers‘
 Don't drink caffeinated beverages at bedtime.
 Don't eat a large or spicy meal in the evening.
 Don't drink alcohol within 4 hours of going to bed.
 Don't take long daytime naps. If you're so tired that
it's not safe to get behind the wheel of your car (or
chop the veggies for dinner), a short 10-minute nap
can be a lifesaver.
 But, don't sleep for much longer or you may not
sleep that night.
 Don't exercise close to bedtime.

54. Sleep Inducing Foods(!)
 Sleep inducing foods have natural properties
that help us relax and prepare our body for a
restful night's sleep.
 They contain the amino acid tryptophan that
has a calming effect on the brain, which makes
it easier to fall asleep and stay asleep.
 Our body converts tryptophan into the
hormones serotonin and melatonin.

55.  Good sources of Tryptophan are milk,
bananas, turkey and green leafy vegetables.
 So, a good bedtime snack is milk and
bananas, a lettuce and turkey sandwich, or
a bowl of cereal with milk.

56. Foods that Keep You Awake
 Heavy, spicy foods such as chilli or curries
 Drinks or foods that contain caffeine, such as
chocolate, tea, coffee, and colas
 Alcohol. Although a "night cap" may help to fall
asleep quickly, it can also make you restless.
 Foods that are high in sugar and fat.

57.  Foods that contain high levels of MSG,
which is a stimulant
 Fried foods such as burgers and french
fries
 Smoked meats such as bacon, sausage,
and ham
 Soy products

58. Acupressure for Insomnia
 A longitudinal study by Sun et al found
that acupressure treatment can
improve insomnia, with effects lasting
after the end of intervention.
 In a randomized controlled trial in 50
residents in long-term care facilities, 5
weeks of standard acupressure on the
HT7 (Shenmen) points of both wrists
significantly reduced insomnia, with
the benefit persisting for up to 2
weeks afterwards.

59. Recent studies on Sleep
Mental Disease
 A new study suggests that treating sleep
disorders, and sleep apnea in particular, is
associated with improvement over baseline in
symptoms of comorbid psychiatric disorders.
 The results were presented at the American
Psychiatric Association's (APA's) 2012 Annual
Meeting.
 May 9, 2012 (Philadelphia, Pennsylvania)

60. Diabetes
 Sleep restriction (5 h/night) for 1 week
significantly reduces insulin sensitivity, raising
concerns about effects of chronic insufficient
sleep on disease processes associated with insulin
resistance.
 Brigham and Women's Hospital, Boston,
Massachusetts: 09/23/2010; Diabetes. 2010;59(9):2126-
2133. © 2010 American Diabetes Association, Inc.

61. Lack of Sleep Linked to Breast Cancer Aggressiveness
(In Postmenopausal Women Only)
 September 7, 2012 — Lack of sleep has been
associated with more aggressive breast cancers,
according to findings published in the August issue
of Breast Cancer Research and Treatment.
 The study was conducted in 101 women with early-stage
estrogen-receptor-positive breast cancer.
 Specifically, having fewer than 7 hours of sleep a
night during the 2 years before the diagnosis was
associated with a greater risk for recurrence.

62. Cancer in shift workers
 Men working at night had approximately double the risk
of those who did not work the night shift for many
different cancers, according to a Canadian case–
control study published in November 1, 2012 issue of
the American Journal of Epidemiology.
 The study compared 3137 men with cancer and 512
matched control subjects who completed a detailed
questionnaire about occupational work and lifestyle from
1979 to 1985.
 Compared with men who never worked at night, men who
worked night shifts had an increased risk for prostate
cancer, non-Hodgkin's lymphoma, pancreatic, rectal,
colon, bladder and lung cancer.

63. Poor Food Choices
 New research suggests that sleep-deprived
adolescents make less healthy food choices than
their well-rested peers, which may be a factor in the
association between sleep and obesity, the research
team says.
 They found that adolescents who slept fewer than 7
hours each night were less apt to eat fruits and
vegetables and more apt to eat fast food.
 SLEEP 2013: Associated Professional Sleep Societies 27th Annual
Meeting. Abstract 0294. Presented June 4, 2013.

64. Longitudinal Study Ties Short Sleep
to Weight Gain in Older Adults
 Men and women aged 50 to 71 who slept for six hours
or less per night gained more weight than those who
slept seven to eight hours, Dr. Qian Xiao of the
National Cancer Institute in Rockville, Maryland and
colleagues found.
 And normal-weight people who reported sleeping less
than five hours each night were about 40% more likely
to develop obesity during follow-up.
 Am. J. Epidemiol. (2013) doi: 10.1093/aje/kwt180 First published
online: September 18, 2013

65. Adding Sufficient Sleep to Four Healthy
Habits Further Lowers CVD Risk
 The Monitoring Project on Risk Factors for Chronic
Diseases (MORGEN) study looked at how adequate sleep
might enhance the benefits of being physically active, eating
a healthy diet, not smoking, and drinking alcohol in
moderation.
 Getting at least seven hours of sleep a night further lowers
the risk of CVD events--on top of the lowered risk from
following four traditional healthy habits--according to a
large, population-based study in the Netherlands published
in the July 2, 2013 issue of the European Journal of Preventive
Cardiology

66. Insomnia Linked to Increased Stroke
 Results showed that overall, insomniac patients had
an 85% higher risk of developing stroke. This was
reduced to 54% after adjustment for other factors.
 The effect seemed to be much greater in younger
people, with patients with insomnia aged 18 to 34
years having an 8-fold higher risk for stroke than
those of a similar age without insomnia.
 Stroke. Published online April 3, 2014

67. Brain Clears Toxins During Sleep
 Scientists have long wondered why sleep is restorative and
why lack of sleep impairs brain function.
 Proteins linked to neurodegenerative diseases, including β-
amyloid (Aβ), are present in the interstitial space
surrounding cells in the brain. In a series of experiments,
researchers tested the hypothesis that Aβ clearance is
increased during sleep and that the sleep-wake cycle
regulates the glial cell–dependent g-lymphatic system,
which is responsible for clearing waste from the brain and
spinal cord.
 Science. 2013;342:373-377

68. The Takeaway
 It can be tempting to trade sleep for a few precious
hours of wakefulness, but it is important to consider
the hidden costs. Sleep is precious, too.
 Numerous studies have found that insufficient sleep
increases a person's risk of developing serious
medical conditions, including obesity, diabetes,
cardiovascular disease and cancer.
 Lack of adequate sleep over time has been
associated with a shortened lifespan.

69. Any Questions?
THANKS
FOR YOUR
ATTENTION!