Sleep,

Manisha Witmans, MD, FRCPC, FAASM
Brainworks Conference 2013
Conflict of Interest
•  Previous sleep and research funded by: AIHW, CIHR
•  Medical Director: Sound Sleep Solutions
•  Co...
Objectives
•  To dispel common myths about sleep
•  Provide practical tips about good sleep
•  Resources for sleep
Myth
Sleep is a Waste of Time
The Evolution
•  Thomas Edison: “Sleep is a criminal waste
of time and heritage from our cave days”
•  Margaret Thatcher: ...
Sleep is VITAL
•  90 yr old = will sleep 32 years (36% of lifetime)
•  Infant – first year – at least ½ of her/his life sl...
Why We Sleep?
•  For Restoration
–  Genes turned on during sleep
–  Slow wave sleep

•  Energy Conservation
–  Only 110 ca...
Sleep-Wake
Continuum

SLEEP

WAKE
Sleep IS Important
Sleep deprivation can cause:
•  Impaired cognitive, social and behavioral performance
•  Poor school pe...
Sleep
Dysfunction:
Conceptual Framework
Insufficient Sleep
(Sleep Deprivation)

Fragmented Sleep
(Sleep Disruption)

Exces...
Perception of Sleep Deprivation

Slide	
  courtesy	
  of	
  Dr.	
  Ruth	
  Benca	
  
Myth
Sleep loss does not affect me
I can make up for sleep deprivation
….6450, 6451,
6452….
I think I can…..
I think I can...
Sleep
Deprivation/Loss
•  Weight gain (50% chance of obesity at 5 hrs of sleep) –
–  Less loss of fat when dieting if you ...
Sleep Deprivation
•  Average sleep time 2013: 6.5 hrs
•  Current sleep time 2013: 5 hrs
•  The “at risk”: shift work, teen...
Sleep
INCREASES/IMPROVES:
•  Attention
•  Concentration
•  Creativity
•  Ability to socialize
•  Decision making
•  Mental...
Drowsy Driving
and Auto
Accidents
•  The peak age for fallasleep driving
accidents is 20 years

www.car-accidents.com/page...
Myth
Sleep, Oh Beautiful and Perfect Sleep
Reality: Shame and Blame
• 
• 
• 
• 
• 
• 
• 

Bedtime troubles is __________’s fault!
S/he will outgrow it
I am the only ...
The facts:
•  Bedtime troubles are common in children
–  Increased likelihood if developmental disabilities
–  Can become ...
The facts:
•  Alcohol and caffeine are not sleep aids. They
disrupt sleep
•  Medications in adults do exist but even for
t...
Social
pressures

School start
times

Substance
abuse

Delayed sleep
phase

Slee
p
Time

Genetic
predisposition

Hormonal
...
Slide courtesy of Jodi Mindell
Myth: Giving In
•  It’s late and I am tired, many nights of this
and I will give in….have the kid come to
bed….
The Facts:
•  Pick your battles
•  Timing can be critical and use it to your
advantage
•  This about gains in small increm...
Myth
Electronics before bed are okay
The Facts:
•  Sleep will be more agitated and can hinder
sleep quality
•  Children stay up longer, sleep less, and wake
up...
Myth
Snoring is normal
Snoring is NOT Normal
•  Snoring can be a sign that a child/adult has
sleep apnea
–  Anyone can be affected
–  Can present...
Snoring is NOT Normal II
•  Risk Factors:
–  Big tonsils and adenoids (children)
–  Asthma
–  Allergies
–  Family history
...
Myth
Watching television helps me fall
asleep
Data About Television and Sleep
•  Preschool children that watch television before bed
have:
–  More disrupted sleep
–  Mo...
Myth
I can do whatever I want before
bedtime and sleep well
RESULTS: cravings – drugs, stimulants, caffeine,
nicotine, alcohol – uppers and downers… an
attempt at control…
Myth: Sleep Aids = Training Wheels
•  Training Wheels:
–  Wibble Wobble Method: Doug Engelbart
•  See-saw back and forth
•...
•  Recommended Maximum Caffeine Intake
Levels for Children (Health Canada)
4 - 6 years 45 mg/day
7 - 9 years
62.5 mg/day
1...
Clues to Increased Need for Sleep
• 
• 
• 
• 
• 
• 

Need an alarm clock to wake up daily
Excessive use of stimulants
Need...
Getting Enough Sleep
•  Nightly sleep needs:
–  Most adults need 6-8 hrs
–  Most children age 8-12 yrs need 9-11 hrs
–  Mo...
Myth
I can do whatever I want before
bedtime and sleep well
Data About Television and Sleep
•  Preschool children that watch television before bed
have:
–  More disrupted sleep
–  Mo...
Sleep Disrupters
• 
• 
• 
• 
• 
• 
• 
• 

Caffeine
Nicotine
Alcohol
Medications
“Busy bedroom”
Exercising before bed
Eatin...
Sleep Promoting Tips
• 
• 
• 
• 
• 
• 
• 
• 

Consistent bedtime routine
Regular exercise earlier in the day
Avoid a busy ...
Myths
•  Sleep problems are easy to fix with a pill
•  There is a magic pill
•  Everyone is the same
Conclusions
•  Sleep is important and worthy of being
nurtured for good health
–  Good sleep habits are essential no matte...
Brainworks 2013
Brainworks 2013
Brainworks 2013
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Brainworks 2013

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Brainworks 2013

  1. 1. Sleep, Manisha Witmans, MD, FRCPC, FAASM Brainworks Conference 2013
  2. 2. Conflict of Interest •  Previous sleep and research funded by: AIHW, CIHR •  Medical Director: Sound Sleep Solutions •  Consultative Services for Stollery Children’s Hospital and Department of Pediatrics, Sleep Medicine and interpretation of ambulatory home testing
  3. 3. Objectives •  To dispel common myths about sleep •  Provide practical tips about good sleep •  Resources for sleep
  4. 4. Myth Sleep is a Waste of Time
  5. 5. The Evolution •  Thomas Edison: “Sleep is a criminal waste of time and heritage from our cave days” •  Margaret Thatcher: “Sleep is for wimps” •  Money does not sleep! •  It is not an upgrade option… BUT SLEEP IS NOT THE ENEMY, WE ARE!!!
  6. 6. Sleep is VITAL •  90 yr old = will sleep 32 years (36% of lifetime) •  Infant – first year – at least ½ of her/his life sleeping •  It is as important as AIR and WATER for SURVIVAL! •  Historically, we knew its importance…not why
  7. 7. Why We Sleep? •  For Restoration –  Genes turned on during sleep –  Slow wave sleep •  Energy Conservation –  Only 110 calories saved from not sleeping •  Brain Processing and Memory Consolidation –  Enhances creativity by 3 fold – synaptic connections strengthened…. –  Brain development - critical •  Overall – mental function, immune function, growth and tissue repair
  8. 8. Sleep-Wake Continuum SLEEP WAKE
  9. 9. Sleep IS Important Sleep deprivation can cause: •  Impaired cognitive, social and behavioral performance •  Poor school performance and lower grades •  Tardiness and absence from school/work •  Difficulty remaining alert, less ability to concentrate •  Irritability and impaired mood •  Increases in substance abuse •  Drowsy driving, injury and possibly, death –  Being sleep deprived is as dangerous as DRUNK DRIVING
  10. 10. Sleep Dysfunction: Conceptual Framework Insufficient Sleep (Sleep Deprivation) Fragmented Sleep (Sleep Disruption) Excessive Daytime Sleepiness Primary Disorders of Excessive Daytime Sleepiness Circadian Rhythm Disorders
  11. 11. Perception of Sleep Deprivation Slide  courtesy  of  Dr.  Ruth  Benca  
  12. 12. Myth Sleep loss does not affect me I can make up for sleep deprivation ….6450, 6451, 6452…. I think I can….. I think I can….. I think I can…..
  13. 13. Sleep Deprivation/Loss •  Weight gain (50% chance of obesity at 5 hrs of sleep) – –  Less loss of fat when dieting if you don’t sleep well (Van Cauter, Sleep, 2012) –  Risk of obesity with sleep loss in children (Chaput, J Public Health, 2011) –  Increased risk of obesity with sleep fragmentation (Narang, CMAJ, 2013) •  Injury –  86% increase in risk for injury in 3-5 yr old with < 10 hrs of sleep per night the night before the accident (boto LR, Sleep Medicine, 2012) •  Risk taking behavior –  Teens - More likely to gamble (Beebe, 2012)
  14. 14. Sleep Deprivation •  Average sleep time 2013: 6.5 hrs •  Current sleep time 2013: 5 hrs •  The “at risk”: shift work, teens, jet lag, etc. •  Microsleeps: your brain coping: 31% drivers will fall asleep at the wheel at least once in their life… can be deadly!!!
  15. 15. Sleep INCREASES/IMPROVES: •  Attention •  Concentration •  Creativity •  Ability to socialize •  Decision making •  Mental health •  Physical health DECREASES: •  Mood changes •  Stress •  Impulsiveness •  Fatigue •  Anger •  Inattention •  Risk taking behaviour (drink and take drugs)
  16. 16. Drowsy Driving and Auto Accidents •  The peak age for fallasleep driving accidents is 20 years www.car-accidents.com/pages/accident_story/3-8-04.html
  17. 17. Myth Sleep, Oh Beautiful and Perfect Sleep
  18. 18. Reality: Shame and Blame •  •  •  •  •  •  •  Bedtime troubles is __________’s fault! S/he will outgrow it I am the only one affected by it…. I need to take care of the other stuff I must be doing something wrong There must be a magic pill Nobody listens or can help
  19. 19. The facts: •  Bedtime troubles are common in children –  Increased likelihood if developmental disabilities –  Can become lifelong •  Over the counter preparations, although have sleepiness as a side effect may not address the underlying reason for the sleep problem •  It is best to work with a health professional knowledgeable about sleep to address the concerns
  20. 20. The facts: •  Alcohol and caffeine are not sleep aids. They disrupt sleep •  Medications in adults do exist but even for them recommended for short term and in conjunction with behavioral strategies •  More is not always better – melatonin…
  21. 21. Social pressures School start times Substance abuse Delayed sleep phase Slee p Time Genetic predisposition Hormonal influence, obesity
  22. 22. Slide courtesy of Jodi Mindell
  23. 23. Myth: Giving In •  It’s late and I am tired, many nights of this and I will give in….have the kid come to bed….
  24. 24. The Facts: •  Pick your battles •  Timing can be critical and use it to your advantage •  This about gains in small increments •  Rome was not built in a day
  25. 25. Myth Electronics before bed are okay
  26. 26. The Facts: •  Sleep will be more agitated and can hinder sleep quality •  Children stay up longer, sleep less, and wake up more •  The bedroom should only be used for sleep •  The bedroom should be a sanctuary
  27. 27. Myth Snoring is normal
  28. 28. Snoring is NOT Normal •  Snoring can be a sign that a child/adult has sleep apnea –  Anyone can be affected –  Can present as: •  Increased work of breathing •  Apneas (holding breath during sleep) •  Waking up tired/daytime irritability •  Social/Marital/Academic Problems •  Risk of injury
  29. 29. Snoring is NOT Normal II •  Risk Factors: –  Big tonsils and adenoids (children) –  Asthma –  Allergies –  Family history –  Facial features (small jaw, big tongue) –  OBESITY –  Non-Caucasian
  30. 30. Myth Watching television helps me fall asleep
  31. 31. Data About Television and Sleep •  Preschool children that watch television before bed have: –  More disrupted sleep –  More nightmares –  More awakenings –  More bedtime resistance •  Can cause behavioral sleep issues in children
  32. 32. Myth I can do whatever I want before bedtime and sleep well
  33. 33. RESULTS: cravings – drugs, stimulants, caffeine, nicotine, alcohol – uppers and downers… an attempt at control…
  34. 34. Myth: Sleep Aids = Training Wheels •  Training Wheels: –  Wibble Wobble Method: Doug Engelbart •  See-saw back and forth •  Feel for the relationship between tilting, steering and untilting and refining the motion while moving forward
  35. 35. •  Recommended Maximum Caffeine Intake Levels for Children (Health Canada) 4 - 6 years 45 mg/day 7 - 9 years 62.5 mg/day 10 - 12 years 85 mg/day Many other ‘hidden’ caffeine sources.
  36. 36. Clues to Increased Need for Sleep •  •  •  •  •  •  Need an alarm clock to wake up daily Excessive use of stimulants Need or take naps Falling asleep at unexpected times/situations Sleeping in on weekends Noticeable change in ability to function when given opportunity to sleep
  37. 37. Getting Enough Sleep •  Nightly sleep needs: –  Most adults need 6-8 hrs –  Most children age 8-12 yrs need 9-11 hrs –  Most teenagers need about 9.25 hrs •  Puberty related change in timing of sleep-wake cycle –  Later sleep time and later wake time
  38. 38. Myth I can do whatever I want before bedtime and sleep well
  39. 39. Data About Television and Sleep •  Preschool children that watch television before bed have: –  More disrupted sleep –  More nightmares –  More awakenings –  More bedtime resistance •  Can cause behavioral sleep issues in children
  40. 40. Sleep Disrupters •  •  •  •  •  •  •  •  Caffeine Nicotine Alcohol Medications “Busy bedroom” Exercising before bed Eating large meals before bed Watching television to fall asleep
  41. 41. Sleep Promoting Tips •  •  •  •  •  •  •  •  Consistent bedtime routine Regular exercise earlier in the day Avoid a busy bedroom Avoid bright light at night Avoid stimulating activities before bed Avoid the sleep disrupters Establish good sleep habits even in your children A cool, dark, quiet bedroom
  42. 42. Myths •  Sleep problems are easy to fix with a pill •  There is a magic pill •  Everyone is the same
  43. 43. Conclusions •  Sleep is important and worthy of being nurtured for good health –  Good sleep habits are essential no matter how old you are •  Sleep can impact many others facets of life and should not be taken for granted •  Invest in your future – take care of your sleep…

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