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Sleep health

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Sleep health

  1. 1. 健康與科技:以睡眠為例 蕭富仁
  2. 2. Sleeping and Waking• 猜猜看?那件事我們大約每天花8個小時,每週56小時,每月224小 時,每年2,688個小時,來從事這項活動?• 王子望著沈睡中的公主,忍不住地親了公主一下;就在那時侯沈睡一 百年的公主竟醒過來了!
  3. 3. What Is Sleep?• Sleep is biologically regulated• Circadian rhythms• Melatonin secretion linked to light-dark cycles• Some adults report needing 7-9 hours a night• 70-year-old “Miss M.” gets by on one hour per night!
  4. 4. Sleep Is an Altered State of Consciousness• Sleep: Awareness of the outside world is turned off (mostly)• So why don’t we fall out of bed?• EEG: The brain is active in sleep
  5. 5. Stages of Sleep• Sleep is not an “on-off” event• Sleep stages• Historically: 5 distinct stages• Currently: Stages 3 & 4 are now joined
  6. 6. REM Sleep• The sleep cycle reverses after about 90 minutes• Enter REM (paradoxical) stage• Most dreaming occurs in REM sleep• Amount of time spent in REM increases• Cycle through this pattern around 5 times per night
  7. 7. Infant Sleep Patterns• Infant mammals show a large percentage of REM sleep• In human, 50% of sleep in the first 2 weeks of life is REM sleep (premature infants: up to 80%)• Human infants can move directly from an awake state to REM sleep, by about 4 months of age, REM sleep is entered through a period of SWS• REM sleep of infants is quite active: 可能與腦部神經之刺激與發育有關
  8. 8. 睡眠與年齡• 隨著人老化,睡眠的型態也跟著改變。嬰兒的睡眠時間 較長,而且其快速動眼期也比大孩子和成人來的高。• 例如:新生嬰兒每天大約睡16小時,其中有一半的 時間是在快速動眼期。老年人(50-85歲) 每天只睡 5.75-6 小時,其中13.8-15% 的時間是快速動眼期。
  9. 9. Pattern of Sleep in Elderly Persons• 貓空夜未眠!• A decline of total amount of sleep• Increase in the number of awakening during a night• Lack of sleep or insomnia(失眠)• Dramatic progressive decline is in stage 3 and 4 sleep (by age 90, stages 3 and 4 has disappeared, causing sleep dissatisfaction) Young adult Elderly person
  10. 10. How I hate to get out of bed in the morning!
  11. 11. Sleep Is an Adaptive Behavior• Sleep serves important biological purposes: – Restoration – Circadian rhythms – Facilitation of learning
  12. 12. Restoration and Sleep Deprivation• Restorative Theory: Sleep allows the body to rest and repair itself• The evidence: – Sleep increases after strenuous physical activity – Growth hormones secreted in sleep – Replenishes the brain’s energy stores – Strengthens the immune system
  13. 13. Restoration and Sleep DeprivationEffects of sleep deprivation:• Mood problems (e.g., irritability)• Decrements in cognitive performance (e.g., attention and short-term memory lapses)• May compromise the immune system• Falling asleep for a few seconds to a minute (microsleeps) can impair ability to perform critical tasks (e.g., driving)
  14. 14. Nap• 瞌睡 – 可愛小孩 – 可愛小貓• 瞌睡 – 防瞌睡系統
  15. 15. Nap on refreshment and memory Refreshment 4 *** * 3 ** Memory SSS rating *** 2 * * 5 1.5 1 Increase in Speed (Seq / Trial) 1.0 4 Increase in Word Pair 0 0.5 S2 SWS Wake 3 0.0 Before Nap *** : S2 vs. Wake, p < 0.001 After Nap S2 vs. SWS, p = 0.009 -0.5 ** : SWS vs. Wake, p = 0.006 2 -1.0 * -1.5 1 1.0 * * -2.0 0.5 -2.5 0 S2 SWS WakeIncrease in Sleepiness S2 SWS Wake 0.0 * : S2 vs.Wake, p = 0.005 S2 * : S2 vs.Wake, p = 0.001 -0.5 S2 SWS SWS Wake Wake -1.0 -1.5 -2.0 S2 SWS Wake S2 vs. Wake, p < 0.001 S2 SWS S2 vs. SWS, p = 0.014 Wake SWS vs. Wake, p = 0.002 17
  16. 16. Circadian RhythmsCircadian rhythm theory:• Many creatures are quiet and inactive during the night because darkness is the time when danger is highest• Reduced risk of exposure to predators• Humans: Are adapted to sleep at night because our early ancestors were more at risk in the dark
  17. 17. Facilitation of LearningSleep: Strengthens neural connections needed for learning to occur• Research shows memory in participants who slept was greater than those who didn’t (Drosopoulos, Schulze, Fischer, & Born, 2007)• REM and slow-wave (stages 3 & 4) important for learning to take place• Participants who completed a complex task and later dreamed about it subsequently performed better on the task than non-dreaming participants (Wamsley, Tucker, Payne, Benavides, & Stickgold, 2010)• Students spend more time in REM during exam periods
  18. 18. preattentive scanning vs. focal attention (visual discrimination)
  19. 19. Visual discrimination learning requires sleep after learning Maquet, Nature Neurosci., 3, 1235-6, 2000. Stickgold et al., Nature Neurosci., 3, 1237-8, 2000.
  20. 20. Two-stage improvement during sleep after learningGais et al., Nature Neurosci., 3, 1335-9, 2000.Karni and Sagi, Nature, 365, 250-2, 1993.
  21. 21. Miller, Science, 315, 1360-1363, 2007.
  22. 22. EEGs during waking and sleep
  23. 23. Block diagram TI CC2430 EEG × 2 EOG × 1 Time1 8051 EMG × 1 StoringAirflow × 1 ADC RAM Micro-SD Card TI CC2430 ECG × 1 Time1 8051Respiratory Storing Bands × 2 ADC RAM Micro-SD Card TI CC2430 Time1 8051 SaO2 × 1 SpO2 × 1 ADC RAM Storing 31 Micro-SD Card
  24. 24. 眼罩型睡眠記錄分析 32
  25. 25. People Dream while Sleeping• Dreams: Products of an altered state of consciousness in which images and fantasies are confused with reality
  26. 26. REM Dreams and Non-REM Dreams• REM dreams: More likely to be bizarre and include intense emotions, visual and auditory hallucinations, and uncritical acceptance of illogical events• Non-REM dreams: Relatively dull (e.g., what sweater should I wear?)
  27. 27. REM Dreams and Non-REM DreamsExplanation:• Non-REM: General de-activation of many brain regions• REM: Brain structures associated with motivation, emotion, reward, vision are active; pre-frontal cortex is not
  28. 28. What Do Dreams Mean?Freud: Dreams contain hidden content that represents unconscious conflicts• Manifest content: The plot of a dream; the way the dream is remembered• Latent content: What a dream symbolizes; the material that is disguised in a dream to protect the dreams from confronting direct reality• No scientific evidence that dreams represent hidden conflicts or for the special symbolic meaning of dream images
  29. 29. Activation-Synthesis TheoryThe theory:• The brain tries to make sense of random brain activity that occurs during sleep by synthesizing the activity with stored memories (Hobson et al., 2000)• Emotion centers (limbic system) in the brain are active, which explains the intense emotions; frontal cortices are not active, which explains the uncritical acceptance of illogical events
  30. 30. Activation-Synthesis TheoryThe critics:• Dreams are not as chaotic as the activation- synthesis theory suggests (Domhoff, 2003)• Often similar to “everyday life” waking experience
  31. 31. Evolved Threat-Rehearsal Theory• Thought question: Why do people often dream about threatening events?• Answer: Perhaps dreams help us prepare to cope with real waking events.• Dreams sometimes simulate threatening events so that people can rehearse strategies for coping (Revonsuo, 2000)• Dreams may have adaptive value if rehearsal helps us survive and reproduce
  32. 32. Sleep Disorders• Insomnia: Difficulty falling or staying asleep[12- 20% adults, female > male, elderly > young]• Obstructive Sleep Apnea (OSA): Breathing may stop hundreds of times per night• Narcolepsy: Sufferers unexpectedly fall asleep• REM Behavior Disorder: Sufferers act out their dreams• Somnambulism: Sleep walking
  33. 33. Clinical Features of OSA 無法熟睡打鼾 晨醒頭痛 夜間頻尿 注意力不集中 性情改變白天嗜睡
  34. 34. Obstructive sleep apnea and treatment
  35. 35. Obstructive sleep apnea and continuous positive airway pressure (CPAP)
  36. 36. insomnia失眠症• Most common sleep disorder• primary insomnia(原發性失眠) >1 month secondary insomnia (次發性失眠) --- about 80% ( heart and lung diseases, pain, anxiety, depression, sleep apnea, restless legs syndrome)• PSG ---- R/O apnea, RLS• lifestyle changes, avoid substances, good bedtime habits include, cognitive-behavioral therapy, medicines
  37. 37. 失眠治療的方式藥物治療衛生署許可的藥物治療,常見的有benzodiazepine (BZD)、non-BZD用藥 (台灣一年吃下的安眠鎮靜藥丸超過13億顆,藥費超過10億元。藥物治 療雖然能幫助入睡,但患者隔天的精神、活動力都大受影響,也易有藥 物依賴的困擾。)off label use(適應症外使用)如鎮靜性抗鬱劑、抗癲癇劑、抗精神病劑、 抗組織胺和褪黑激素可供使用非藥物治療包含了認知和行為方面的治療,方法有:刺激控制治療法( stimulus control instructions )睡眠限制治療法( sleep restriction therapy)放鬆訓練(relaxation trainings)生理回饋法(biofeedback)認知治療(cognitive therapy)光照治療(light therapy) 46

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