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Sleep Medicine: An Overview
The document provides an overview of sleep medicine, highlighting the importance of sleep for health and productivity, as well as the consequences of sleep disorders such as sleep apnea and insomnia. It details methods used in sleep studies, various sleep stages, and the impact of conditions like restless legs syndrome and parasomnias. The document also offers treatment options for sleep disorders and emphasizes the importance of good sleep habits.
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Sleep Medicine: An Overview
- 1. SLEEP MEDICINE: An Overview FraserWillsey, BA, RPSGT Sleep Lab Technologist Sleep Disorders Service, The Royal
- 2. Why Study Sleep? •We spend 1/3 of our lives sleeping • 1 in 7 Canadians are not getting enough sleep (Statistics Canada, 2002) • Severe health consequences - DEATH! • Sleep deprivation costs $150 BILLION/yr in lost productivity (Nat’l Commission on Sleep Disorders, 2003)
- 3. THE IMPACT OFSLEEP DEPRIVATION
- 4. • Challenger Disaster •3 Mile Island • Chernobyl
- 5. Purpose of Sleep •Restorative Function • Energy Conservation • Immune Function Regulation • Memory Consolidation • Mood Regulation and depression • Protective Mechanism
- 7. WHAT WE DOAT THE SLEEP LAB….
- 9. What Happens atthe Sleep Lab… • ROMHC: 6 bed clinical lab, 4 bed research lab STEPS: 1) → Referral 2) → Consultation with a Sleep Specialist 3) → Overnight Sleep Study 4) → Data is Analyzed by RPSGTs 5) → Results Appt with a Sleep Specialist
- 10. How Do WeMeasure Sleep in the Laboratory? • EEG – brainwaves (Central & Occipital Leads) • EOG – eye movements • EMG – muscle tone • EKG/ECG – heart • Breathing: 1)Airflow & 2) Effort: Thoracic & Abdominal • Blood oxygen saturation (SaO2) • Snore mic. • Digital AV recording
- 14. STAGES OF SLEEP •NREM & REM • NREM = N1, N2, N3 • Sleep Cycle • REM increases as the night progresses • Changes across the lifespan
- 15. NREM SLEEP • N1:lightest stage of sleep (hypnic jerks/sleep starts), dozing • N2: Sleep spindles & K complexes • N3 (formerly stages 3 & 4): deepest most physically restorative stage of sleep. More difficult to awaken from this stage. Decreases with age. • Breathing regular, heart rate decreases
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- 21. REM Sleep • RapidEye Movements • Muscle atonia (paralysis) • Dream recall • 90 minute latency • “Paradoxical Sleep” – EEG mimics wakefulness • Breathing irregular, heart rate fluctuates
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- 25. SLEEP APNEA • TwoTypes: Obstructive & Central • Pauses in breathing > 10 seconds in length • Respiratory Disturbance Index: >5 hr =clinically significant • Symptoms: ▪ Excessive daytime sleepiness (EDS) ▪ morning headaches ▪ SNORING***** ▪ pauses in breathing ▪ waking with a dry mouth ▪ nocturia ▪ Gastroesophageal reflux disease ZZZZzzzzzzZZZZzzzzzz
- 26. OBSTRUCTIVE SLEEP APNEA(OSA) • Causes ▪ Narrow Upper Airway ▪ Elevated BMI ▪ Family Hx • Exacerbated by: ▪ Rx ▪ Alcohol Consumption ▪ Supine sleep ▪ REM sleep ▪ **Supine + REM sleep
- 27. Normal vs. CollapsedAirway
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- 32. TREATMENTS FOR OSA •**CPAP – Continuous Positive Airway Pressure • **Weight Loss - ↓ BMI = ↓ RDI • Avoid Alcohol Consumption • Avoid Sedative Medications • “Snoreball” Technique / Positional Therapy • Oral Appliance • Upper Airway Surgery – Tonsilectomy – Laser Surgery – Tracheostomy – Uvulopalatopharyngoplasty (UPPP)
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- 36. Consequences of UntreatedOSA • Memory Problems • Depression • Cardiovascular disease –High blood pressure –Stroke –Cardiac arrhythmias
- 39. FASTEN YOUR SEATBELTS… THERE’SANOTHER CONSEQUENCE OF UNTREATED OSA & SLEEPINESS ANY GUESSES WHAT IT IS?
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- 44. PARASOMNIAS • NREM Sleepwalking (Somnambulism) SleepTerrors (aka Night Terrors) Others examples: Sleep Related Eating Disorders, Confusional Arousals, Somniloquy ■ REM REM Behaviour Disorder (RBD) Measured in the sleep lab with full EEG to rule out seizure activity
- 45. SLEEPWALKING • Stage N3(slow wave sleep) • Common in children • Do not awaken. Secure the environment • No recall of a dream or of the episode • Aggravated by sleep deprivation, stress, alcohol • Positive family history • Perform complex behaviours with heightened pain threshold
- 46. JAROD ALLGOOD Feb. 2,1973 – Feb. 9, 1993
- 47. REM Behaviour Disorder(RBD) • No muscle atonia during REM sleep • Ability to act out complex dream behaviour • Bedpartner often the “victim” • Age of onset: 50 – 60yrs. Males • Usually opposite of waking personality • Case study: “baseball player” at ROMHC
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- 50. Treatments for RBD •Full EEG montage during PSG • CT Scan, MRI – r/o lesions • Securing the environment (mattress on floor, bed rails, restraints) • Bedpartner sleeps in another room • Rx
- 51. SLEEPWALKING vs. RBD SleepwalkingSleepwalking ▪▪Stage N3 (NREM)Stage N3 (NREM) ▪▪ No dream recallNo dream recall ▪▪ ChildrenChildren ▪▪ Not easily awakenedNot easily awakened REM BehaviourREM Behaviour DisorderDisorder ▪▪ REM sleepREM sleep ▪▪ Dream recallDream recall ▪▪ Adults (elderly)Adults (elderly) ▪▪ Easily awakenedEasily awakened
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- 53. PLMS Treatment • Rx •Iron supplementation • CPAP if PLMs secondary to apnea
- 54. Restless Legs Syndrome(RLS) • Disorder of WAKEFULNESS (PLMs = sleep) • Subjective report of an uncomfortable sensation in the legs while at rest • Irresistible urge to move the legs • Symptoms subside with movement • “Creeping”, “itching”, “creepy-crawly”, “pulling”, “tugging”, “gnawing”, “toothache in my legs”, “bugs or worms crawling under my skin” • Symptoms worse in the evening • Almost all patients with RLS display PLMs during sleep
- 55. RLS Treatments • Pharmacological(dopamine agonists) • Non-Pharmacological: – Iron supplementation – Warm bath – Exercise – Massage, acupuncture, relaxation techniques – Keeping mind engaged when having to stay seated – Eliminate caffeine and alcohol – Bar of soap under the sheets!
- 56. SLEEP & MEDICALILLNESS
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- 58. SLEEP & MENTALILLNESS • Depression – Early morning awakenings – Short REM latency – Increased time in REM sleep – May mimic narcolepsy on the MSLT
- 59. SLEEP & MENTALILLNESS • Anxiety – Increased sleep onset – Prolonged awakenings – Panic attacks (with/without sleep apnea)
- 60. SLEEP & MENTALILLNESS • Psychiatric Populations and Sleep – Schizophrenia (apnea, sleep spindles) – PTSD (nightmares) – Geriatrics – Mood disorders
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- 62. INSOMNIA • Difficulty initiatingand maintaining sleep • Early morning awakenings • Complaint of poor, insufficient or nonrefreshing sleep • Impact on waking behaviour • Sleep Efficiency < 85% • Longer SOL (> 30 minutes), short total sleep time (TST)
- 63. Insomnia Treatments • CognitiveBehavioural Therapy • Sleep Restriction Therapy • Relaxation Techniques • Sleep Hygiene • Prescription medications
- 64. GOOD SLEEP HABITS •Get up at the same time each morning. Even if you fall asleep very late, you should still get up at the same time each morning • To avoid “Sunday night insomnia, Monday morning blues”, don’t stay up late on weekends and then sleep in • Go to bed only when sleepy • Develop a relaxing pre-sleep ritual such as reading, taking a bath, brushing your teeth, etc
- 65. GOOD SLEEP HABITS •Use the bed only for sleep and intimacy • Nicotine is a stimulant. Try not to smoke near bedtime • Hunger may disturb sleep. Perhaps try to have a light snack before bed. A glass of warm milk contains a natural sleep aid • Exercise regularly. Get vigorous exercise either in the morning or the afternoon and do only mild exercise two to three hours before bed
- 66. GOOD SLEEP HABITS •Don’t stay in bed if you can’t fall asleep within 15 minutes. Tossing and turning will just make you more frustrated • Get as much sleep as you need, but no more • If you find yourself worrying at bedtime, set aside a “worry time” – perhaps 30 minutes in the early evening to write down both problems and solutions
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