Sleep ArchitectureSleep Architecture

REMREM Rapid Eye MovementRapid Eye Movement

NREMNREM Non-Rapid Eye MovementNon-Rapid Eye Movement

Stages 1 and 2 light sleepStages 1 and 2 light sleep

Stages 3 and 4 deep sleepStages 3 and 4 deep sleep

25% REM, 50% Stage 2 and 25% stages 3 and 425% REM, 50% Stage 2 and 25% stages 3 and 4

FatigueFatigue

Effect of fatigue/sleep deprivationEffect of fatigue/sleep deprivation

• IncreasedIncreased irritability and lower stress toleranceirritability and lower stress tolerance

• Low motivation (“Can’t be bothered”)Low motivation (“Can’t be bothered”)

• Faulty judgmentFaulty judgment

• Lapses in attention and vigilanceLapses in attention and vigilance

• Impaired decision making and logical reasoningImpaired decision making and logical reasoning

• Increased risk taking Increased risk taking

FatigueFatigue

Effect of fatigue/sleep deprivationEffect of fatigue/sleep deprivation

• Slowed reaction timeSlowed reaction time

• Susceptibility to illnessSusceptibility to illness

• Increased sensitivity to painIncreased sensitivity to pain

All result in reduction in Performance & SafetyAll result in reduction in Performance & Safety

Three Most Common Sleep Disorders Are…Three Most Common Sleep Disorders Are…

1)1) InsomniaInsomnia

10 – 15% of adults suffer from chronic and severe 10 – 15% of adults suffer from chronic and severe insomniainsomnia

2) The Parasomnias2) The Parasomnias

Up to 10% of the adult populationUp to 10% of the adult population

3) Snoring and Obstructive Sleep Apnoea (OSA)3) Snoring and Obstructive Sleep Apnoea (OSA)Snoring – up to 60% adults snore regularlySnoring – up to 60% adults snore regularlyOSA – 9% of males, 4% females over 40OSA – 9% of males, 4% females over 40

• InsomniaInsomnia

Medical problems associated withMedical problems associated with

InsomniaInsomnia

•Heart Disease x 2.27Heart Disease x 2.27•Cancer x 2.17Cancer x 2.17•Hypertension x 3.18Hypertension x 3.18•Diabetes x 1.8Diabetes x 1.8•Gastrointestinal x 3.33Gastrointestinal x 3.33

Sleep HygieneSleep Hygiene

• To Provide information about lifestyle, and environment that might interfere with sleep, or promote better sleep.

• These strategies are important as a baseline, and should be combined with the other treatments.

• As a sole therapy, it is not effective for the more severe insomnia, but should be addressed in therapy.

Stimulus ControlStimulus Controlfor those with insomniafor those with insomnia

Stimulus Control Stimulus Control is based on classical is based on classical

conditioned responseconditioned response to certain stimuli.to certain stimuli.

This involves This involves strengtheningstrengthening the relationship the relationship

between between bedbed and and sleepsleep, ,

and and breakingbreaking the negative relationship the negative relationship

between between bedbed and and anxietyanxiety and and wakefulnesswakefulness

Important and Effective Important and Effective

Bed Restriction TherapyBed Restriction Therapyfor those with insomniafor those with insomnia

Sleep restriction Sleep restriction therapy is designed to improve therapy is designed to improve

sleep consolidation sleep consolidation and and sleep efficiencysleep efficiency..

This is achieved by initially This is achieved by initially increasingincreasing the the

homeostatic drive homeostatic drive to sleep.to sleep.

Sleep efficiency is improved.Sleep efficiency is improved.

Time in bed can then be increasedTime in bed can then be increased

The most difficult, but the most effectiveThe most difficult, but the most effective

The ParasomniasThe Parasomnias

In Non-REMIn Non-REM

In REMIn REM

Sleep Related Movement DisordersSleep Related Movement Disorders

Restless Leg SyndromeRestless Leg Syndrome

Periodic Limb movements in SleepPeriodic Limb movements in Sleep

The ParasomniasThe Parasomnias

In Non-REM In Non-REM

Sleep WalkingSleep Walking

Night terrors Night terrors

Sleep Related Eating Disorder Sleep Related Eating Disorder

Sexsomnia Sexsomnia

REM related sleep disordersREM related sleep disorders

NightmareNightmare

REM-Sleep Behaviour DisorderREM-Sleep Behaviour Disorder

Sleep Related Movement Disorders:Sleep Related Movement Disorders:Restless Leg syndromeRestless Leg syndrome

Essential featuresEssential features

- Unpleasant sensation in the legs requiring the urge to move- Unpleasant sensation in the legs requiring the urge to move

- Urge to move is worse at times of inactivity- Urge to move is worse at times of inactivity

- Unpleasant sensation is partially or completely relieved by movement- Unpleasant sensation is partially or completely relieved by movement

- Unpleasant sensation is worse in the evening or at night.- Unpleasant sensation is worse in the evening or at night.

Sleep Related Movement Disorders:Sleep Related Movement Disorders:

Periodic Limb Movements in Sleep Periodic Limb Movements in Sleep

- Daytime sleepiness- Daytime sleepiness

- Restlessness during sleep- Restlessness during sleep

- Nighttime arousals- Nighttime arousals

- Observed limb jerking at night. - Observed limb jerking at night.

Typically extension of the big toe,Typically extension of the big toe,

dorsiflexion of the ankle,dorsiflexion of the ankle,

occasional flexions of the knee, and hipoccasional flexions of the knee, and hip

•

•

• •

The Agony or the EcstasyThe Agony or the Ecstasy

Familiar?

Snoring Related ComplaintsSnoring Related Complaints

Drives wife from bedroomGirlfriend won’t marry meShakes entire houseAsk me to leave movies and churchHas had to leave boat so friends could sleepFall asleep at traffic lights waiting for red

light to change

Consequences of Sleep ApnoeaConsequences of Sleep Apnoea

1. Daytime fatigue, especially sleepiness

2. Bed partner sleep disturbance

3. Cardiovascular complications

Consequences of Sleep ApnoeaConsequences of Sleep Apnoea

Medical consequences :-

Hypertension

Insulin Resistance

Cardiac Arrhythmia

Heart Attack

Stroke

Nocturnal GORD

Nocturia

Depression

Risk Factors for Sleep ApnoeaRisk Factors for Sleep Apnoea(Not exclusive)

Male

Increasing age

Body Mass Index > 30

Neck Circumference > 42cm ( 17ins)

Alcohol ( > 2 units)

Smoking

Post Menopausal Women

Sleeping Pills

Laugh and the world laughs with you…

…snore and you sleep alone.

Thank YouThank You

Dr Alex BartleDr Alex Bartle

SLEEP WELL CLINICSLEEP WELL CLINICChristchurch, Auckland, WellingtonChristchurch, Auckland, Wellington

Nelson, Tauranga, WhangareiNelson, Tauranga, Whangarei

www.sleepwellclinic.co.nzwww.sleepwellclinic.co.nz