17 - 2 Flashcards
Mood and Depression
Sleeping difficulty is often reported in those struggling with depression or mood disorders
Risk for depression rises with insomnia
Treating for sleep problems also improves depression
Neurochemical changes make people more vulnerable to depression
A night of poor sleep can make people more irritable the next day
Can affect emotions, more volatile and disinhibited
In adolescents, more risk-taking behaviour is noted when sleep deprived
Sleep problems are correlated with suicides – especially among young adults
Association with insomnia and suicidal thoughts
Being aware of connections between mood and sleep can contribute to better mental health
Dementia affects memory
People with dementia have a hard time storing memories
Is associated with sleep
changes in the fluid that surround the brain during sleep is increased when we’re sleeping, and that can help move out things that are like waste products. If we aren’t able to get rid of those waste products. We can have neurodegenerative problems
Dementia
Major disease as we age
20% of older adults develop memory problems
Sleep may prevent cognitive impairment and dementia
Changes in fluid that surrounds the brain during sleep
Flow of cerebral spinal fluid (CSF) increased by 90%
Allows for waste products of nerve metabolism to clear
Proteins such as amyloids have been associated with Alzheimer’s disease
The glymphatic system clears the waste from the brain
Sleep disruption at night increases the risk of dementia or causes it to develop earlier
Athletic Performance
Sleep can have a profound effect on athletic performance
Adhering to a more rigid sleep schedule student athletes performed better in their sports and in the classroom
Circadian rhythms are also important
Crossing time zones, longer flights increases jet lag in players
East coast teams playing west coast teams were most adversely affected
Growth hormones are also affected with sleep loss
Growth hormone and testosterone are released during sleep – levels are reduced with sleep loss
Testosterone is necessary for muscle health therefore sleep is necessary for optimal performance
Poor sleep can increase Musculoskeletal Pain
Poor sleep can lead to risk of developing body pain and reducing pain threshold
Improving a patient’s sleep can improve pain symptoms
—-A challenge is that pain may interfere with the sleep process
—-Creates a feedback loop
We eat more and gain more weight when we do not sleep
Ghrelin and leptin are affected by sleep
Ghrelin rises when we have not eaten, increasing appetite
Leptin rises after we eat and makes us feel “full”
Sleep deprivation causes leptin levels to fall by 20-30% - ghrelin increases by the same amount
Cardiovascular Disease
Strongest connection is sleep apnea, particularly in people who snore
—Also have hypertension – 2 to 3 times the risk
Hypertension is related to other cardiac disorders
—–Cardiac arrest, strokes and coronary heart disease
—-Sleep apnea promote inflammatory pathways contributing to the plaque in the arteries
—-Cardiac arrhythmias such as atrial fibrillation can be promoted by sleep apnea
—–In males, a sleep duration of less than 6 hours lead to an increased risk of mortality
—–If hypertensive the risk increases
It is recommended that sleep medications not be used as there is an association with a higher mortality risk
Diabetes
Sleep can affect the risk of developing diabetes
In males with short sleep duration, the risk of developing type II diabetes rose two-fold
Those with problems falling asleep had a 50% chance of developing diabetes
Untreated sleep apnea is associated with glucose regulation problems
In young people when slow-wave sleep was disrupted, the ability of insulin to regulate glucose was impaired
Public Health Impact
We risk our own and other’s lives without realizing it due to Increased sleep debt
Auto accidents
- Do not get behind the wheel without enough sleep
–Errors committed by sleep deprivation matched those that were legally drunk
—–Combination of alcohol and sleep deprivation are exponentially lethal
Microsleep
(when accidents occur)
A momentary lapse in concentration can last a few seconds – just long enough to lose control
Your brain loses perception of the outside world; you do not know you have had a microsleep
Occurs most often when getting less than seven hours of sleep
Parents with small children (infants)
Shift workers
Untreated sleep disorders
Peak period is from 4 am to 6 am
Getting Started on a Healthy Sleep Program
Step 1: use sleep diary to help you discover your sleep pattern
Step 2: Identify sleep disrupters that interfere with the ability to fall or stay asleep
a) Reflux - Consider avoiding food and fluid for 3 hours before bedtime
b) Nasal congestion and cough
- bills, sprays, clean sheets
c) Urination
- avoid all fluids 3 hours prior to bedtime
d) Anxiety and stress
- daytime exercise, meditation, wind-down period
e) Pain
- modify bed, cautious with pain medication, talk to doctor
f) Bedroom
- cool, dark, comfortable environment
g) Too much caffeine
Step 3: Improve Sleep Fitness
Lack of sleep
Daytime sleepiness is a major problem for post-secondary students
Dull sedentary situations do not cause but unmasked feelings of sleepiness; a good sign that your waking hours are impaired by a sleep deficit
With adequate and quality sleep; energy, motivation and optimal function should continue throughout the day
If drowsiness is related to insufficient sleep, think about your baseline sleep needs
Depending on your sleep needs try to ensure an eight-hour sleep opportunity
A nap might also compensate for some sleep loss
Longer sleep times on weekends might be helpful too
Social jet lag
- It may be better to avoid sleeping late two days in a row to not disrupt the circadiam rhytham
main disorders of sleep
narcolepsy, sleep apnea, insomnia, and restless leg syndrome.
Chronic Insomnia
conditioned where people have difficulty falling or staying asleep
Insomnia symptoms:
- Usually do not have circadian rhythm issues and do not feel sleepy in the daytime
–Have trouble sleeping not only at night but in the day
—Considered to have chronic insomnia if sleep disruption occurs at three nights per week over a three-month period
Insomnia treatment
Treatment relies on addressing sleep disrupters or circadian rhythm factors
Discover the cause of poor sleep and remedy it
—-Coughing, urination, anxiety, reflux, congestion etc.
—Sleeping pills are not recommended
Sleep routine
(insomnia)
Shorten the sleep period slightly – set a strict sleep window – go to bed at the same time
This Increases the homeostatic pressure to drive sleep onset
Sleep restriction or consolidation approaches are very effective
Daytime naps need to be limited
No biological benefits of oversleeping
Environmental and other factors
(insomnia)
Create a healthy sleep environment
Use bed for sleep only
Exercise daily, but not close to bedtime
Try to avoid screen-based technology to limit exposure to blue light
Professional help
See your physician for referral to a sleep specialist
May be a candidate for sleep study
Restless Leg Syndrome (RLS)
Restless leg syndrome symptoms:
Often a feeling of something crawling under the skin, ache or tingling sensation
Happen more in the evening
–Alleviated by walking around or moving the legs
RLS can be associated with small kicking movements during the night
RLS treatment
–Get more exercise during the day
—Avoid all caffeine and ensure iron levels are in the middle range
–OTC meds like Benedryl® may worsen sleep
Sleep Apnea
symptoms:
Caused by a narrowed airway that gets more obstructed when sleeping
Associated with hypertension, heart attacks and stroke
Negative impact on diabetes
Increase in work-related and motor vehicle accidents
Most common in overweight persons
Loud snoring and a family history – check for possibility of sleep apnea
treatment:
Can have a major impact on quality of life
Lifestyle changes include weight loss, sleep on side, quit smoking using meds to keep nasal passages open at night
Dental devices or continuous positive airway pressure (CPCP) masks and machines
Surgical treatment may include removal of tonsils or adenoids
Narcolepsy
symptoms:
Feel sleepy during the daytime – urge to sleep at inappropriate times
Do not sleep well at night
Transition from sleep to wakening – the REM paralysis lingers
Cataplexy – sudden loss of muscle control
——Can be triggered by strong emotion – laughing hard or getting startled
Treatment:
Few and ineffective
Modafinil helps afflicted people stay awake during the day
Antidepressants suppress REM sleep and the paralysis effects
Contraindicated in pregnant women
