Sleep Health

Question 1

What is sleep health?

Answer 1

Buysse, 2014

• multidimentional pattern of sleep-wakefulness adapted to individual, social and environmental demands, that promotes physical and mental wellbeing
• good sleep health is characterized by
  
  • satisfaction/quality
  • alertness during day
  • timing
  • efficiency
  • duration

Interventions to improve sleep health at the population level

• work environments
• school-times
• prevention research

Question 2

Sleep quality

Answer 2

Crawford & Ong, 2015

• Lack of interruptions
• Fall asleep easily
• Deepness

Measured with Pittsburgh Sleep Quality Index (PSQI) - Buysse et al., 1989

• Hicks et al., 2001 - sleep dissatisfaction is increasing
• Rod et al., 2010 - poor sleep quality = increased mortality risk
• Gilbert & Weaver, 2010 - reduced academic performance with poor sleep quality

Question 3

Interventions to improve sleep quality

Answer 3

CBT and sleep education improve sleep quality and reduce depressive symptoms (Trockel et al., 2011)

• Anchor sleep by consistent wake time
• sleep restriction
• relaxation and mindfulness
• stimulus control
• reduce maladaptive thoughts about sleeping

increase circadiam amplitude (increase darkness at night and light during day)

• increased light levels in the workplace improve sleep quality and overall health of office workers (Bouberki et al., 2014)
• Receiving high levels of light in the morning is associated with reduced sleep onset latency and increased sleep quality (Figueiro et al., 2017)

Exercise

• Improves sleep quality (King et al., 1997)

Question 4

Why is alertness important?

Answer 4

Safety!

• Chernobyl (1986) 4000 deaths bc people less alert working 13hr shifts
• Exxom Valdez (1989) oil spill bc of inadequate sleep - one officer only had a short nap in the 16hrs prior to the accident
• Challenger explosion (1986) - overworked and sleep deprived to make the launch date

Question 5

Interventions to improve alertness

Answer 5

Scheduled naps

• Takahashi et al., 2014 - people maintain better alertness throughout the day with a scheduled nap compared to those who go without
• Mednick et al., 2002 - insomnia severity index threshold increases less from baseline with short nap compared to controls, more with long nap

Light

• Viola et al., 2008 - blue-enriched white light improves self-reported alertness and performance at work, greater evening fatigue (leads to better sleep quality)

Question 6

Sleep timing issues and interventions

Answer 6

Night shift work during day –> poorer sleep quality, less total sleep time (Drake et al., 2004)

Interventions:

• Behavioural therapy (Valleres et al., 2015)
  
  1. Night sleep
     
     • Sleep restriction therapy
     • When sleep efficiency for night sleep = 85%….
  2. Day sleep
     
     • Sleep restriction therapy
     • When sleep efficiency for day sleep = 85%….
  3. Napping
     
     • Scheduled naps using SRT
     • Adapt length & timing of naps to fit lifestyle without interfering with homeostasis process
• Bright light upon waking & during shift + sunglasses on the way home in the morning (Smith & Eastman, 2012)

Question 7

Sleep efficiency and interventions

Answer 7

Insomnia symptoms affect 1 in 3

Interventions:

• CBT-I
  
  • stimulus control therapy
  • sleep restriction therapy
  • cognitive therapy
  • relaxation therapy

Question 8

Poor sleep duration

Answer 8

Keyes et al., 2015

• teenagers naturally delay sleep but have to wake early for school
• only 30% get 7+hrs sleep per night

Lee et al., 2012

• suicide risk increase

Clinkinbeard et al., 2011

• poor sleep duration could account for teenage behaviour
• negative behaviours decreased with healthy sleep

Baum et al., 2014

• Healthy sleep reduces anxiety, depression, fatigue, confusion, increases vigor

Question 9

Interventions to improve sleep duration in teenagers

Answer 9

Delay school start time

• Wahlstrom, 2002 - most sleeping in class occurs during earlier hours
• Wahlstrom et al., 2014 - more students get 8+hrs sleep on school nights
  
  • 8:00am start –> 49.7%
  • 8:35am start –> 60%
  • 8:55am start –> 66.2%
• Wahlstrom, 2002 - improves enrollment rate
  
  • same school had 52.2% continuous enrollment 1996-97, 58.1% 1998-99
• Bowers & Moyer, 2017
  
  • improves sleep duration, and attendance, reduces daytime sleepiness

Question 10

Barriers to changing school start times

Answer 10

Further delays sleep-wake rhythm?

• Dunster et al., 2018 - no affect on bed time but they can sleep later –> improved sleep duration

Increased costs to society, altering community rhythm

• teachers stay later, bus times, parents schedules
• Hafner et al., 2017 - predict that it would improve US state economic outputs
• Parents able to spend time with younger children in the mornings