Sleep Deprivation: Can it kill us? - PowerPoint PPT Presentation

1 / 42
About This Presentation

Sleep Deprivation: Can it kill us?


... (depression) Biological clock ... Cox proportional hazards survival models computed to determine ... sleep deprivation Physical effects of sleep ... – PowerPoint PPT presentation

Number of Views:29
Avg rating:3.0/5.0
Slides: 43
Provided by: neta191


Transcript and Presenter's Notes

Title: Sleep Deprivation: Can it kill us?

Sleep Deprivation Can it kill us?
  • TWUC
  • Betsy R. Sears MSM, MT(ASCP) EVP, Sales
    Support ExamOne

Sleep deprivation
  • One of most pervasive health problems in U.S.
  • Estimated 1.5 hours less/night than a century
  • 2002 Sleep in America poll 5,000 adults 1/3
    need 8 hours but dont get
  • Studies on lt 6 to 7 hours sleep increased
    mortality risk
  • Can affect health


  • Experts say brainpower

  • Sleep - why we need it
  • Reasons we dont sleep
  • Consequences of sleep deprivation
  • Studies statistics
  • Success for sleep

  • Naturally recurring state characterized by
    reduced or absent consciousness, relatively
    suspended sensory activity, and inactivity of
    nearly all voluntary muscles
  • Heightened anabolic state, accentuating growth
    and rejuvenation of the immune, nervous, skeletal
    and muscular systems (all animals)
  • Melatonin triggers functions clears cells of
    toxins, slows respiratory system
  • Purpose only partially clear
  • 2007 American Academy of Sleep Medicine (AASM)
    stages REM Non-REM (N1, N2, N3)
  • Stages assessed by polysomnography EEG, EOG, EMG

Sleep stages
  • NREM sleep
  • N1 drowsy sleep twitching lost muscle tone
    (falling!) 4-5
  • N2 muscle activity and conscious awareness
    eye movement stops
    45-55 adult sleep
  • N3 (deep sleep) no eye or muscle activity
    children - night
    terrors, sleepwalking, bedwetting 6 15
  • REM sleep
  • REM and brain waves at waking levels most
    memorable dreams HR BP male
    erection body temperature fluctuates muscles
    relax (3 to 5 cycles each night) paralysis
    protective 20-25 adult sleep infants 90
  • N1 N2 N3 N1 REM

Sleep cycles
Sleep why we need it
  • After 50 years research, William Dement "As far
    as I know, the only reason we need to sleep that
    is really, really solid is because we get
  • Animals tell us . . . even the sharks
  • Restoration wound healing

    immune system

    somatic growth
  • Ontogenesis REM necessary for brain development
  • Memory processing working memory keeps
    information active for further processing
    supports higher level cognitive function (38
    drop in sleep test 26 min/night/4 days)
  • Preservation and Protective adaptive function
    protect in 24 hr/day

Optimum amount of sleep
  • Varies by age and individual genetics size and
    shape adequate if no daytime sleepiness or
  • Controlled by circadian clock, sleep - wake
    homeostasis, willed behavior
  • Circadian clock works in tandem with adenosine
    (neurotransmitter) high
    levels cause sleepiness melatonin released and
    decrease in body temperature
  • Homeostasis need for sleep as function since
    time last sleep cycle
  • Optimal sleep not meaningful unless timed with
    circadian rhythms
  • University of CA, S.F. 3 of population
    requires 6 hrs or less (DEC2 mutation)
  • Univ of San Diego 1 M adults, longer life
    6-7 hrs sleep/night
  • Other studies - gt 8 hrs/night associated with
    mortality (depression)

Biological clock
Reasons we dont sleep 100 M of us
  • Insomnia - 70 M
  • Sleep apnea or other disorders 18M
  • Eating/drinking habits
  • Restless leg syndrome 12 M
  • Depression 90
  • Noisy bedtime setting
  • Shift working 22M
  • Frequent flyers
  • Medical illness causing pain

  • Acute - Difficulty getting to or staying asleep
    1 night to few weeks
  • Chronic 3 nights a week for a month or longer
  • National Sleep Foundation (NSF) most common of
    all sleep problems Americans overall 58

    Elderly 68

    Males 31

    Females 48
  • Primary - alcohol, anxiety, coffee, stress
  • Secondary physical condition
    asthma, cancer)
  • Treatment nothing, change in sleep habits,
    pills, treat health conditions, behavioral
    therapy Gayle Greene

Sleep Apnea
  • Risks if untreated
  • Stroke 4x more likely
  • Heart disease 4x more likely
  • 3 risk of heart attack and stroke
  • 50 have hypertension
  • 38,000 deaths/yr
  • Prevalence
  • 18 million in the U.S.
  • Children 1-2
  • Male 4-9
  • Female 2-4 (menopause)
  • Elderly 20
  • 2-4 of Americans go undiagnosed (5-10M)

Consequences of sleep deprivation
  • 85 sleep disorders recognized by American Sleep
    Disorders Association (ASDA)
  • 2 hours sleep loss 2 or 3 12 oz. beers
  • Missed 1 night irritable and clumsy easily
    2 nights
    concentration mistakes normal tasks

    3 nights hallucinate lose grasp on reality
  • Few hours sleep each night sleep debt 1997
    study showed persons sleep 4-5 hours/night needs
    2 full nights to recover performance, alertness
  • Morbidity/mortality

Physical effects of sleep deprivation
Sleep deprivation consequences short term
  • Decreased performance alertness
  • Memory cognitive awareness
  • Physical appearance
  • Wound healing
  • Stress relationships
  • Immune system
  • Poor quality of life
  • Occupational injury
  • Automobile injury

Occupational injury
  • gt 10 people die/day due to injuries on the job
    (sleepiness, drugs, alcohol)
  • Non-fatal accidents cost 100 billion/year lost
    wages and productivity, administrative expenses,
    health care, and other costs
  • 2009 National Sleep Foundation 85 police
    officers, 80 regional pilots, 48 air traffic
    controllers have nodded off on the job in past
    year 41 medical workers made fatigue related
  • 1999 American Airlines crash in Little Rock
  • 2003 Staten Island Ferry crash
  • 2009 crash regional jet in Buffalo NY 50 people
  • Exxon Valdez grounding, 3 Mile Island Chernobyl
    nuclear accident
  • 2004 study Harvard Medical School medical
    residents made 2x as many mistakes with lt 4
    hrs/sleep as compared to gt 7 hrs/sleep

Drowsy driving
  • National Center for Sleep Disorder Research
    (NCSDR) National Highway Traffic Safety
    Administration (NHTSA) report that
  • Most car crashes do not involve alcohol
  • Fall asleep crashes more serious higher speed,
    delayed response
  • North Carolina drowsy driving crashes resulted
    in more injury than other non-alcohol related
    crashes Mortality 1.4 vs. 0.5

Automobile injury
  • According to National Highway Traffic Safety
    Administration (NHTSA) drowsy driving causes

    100,000 crashes a year (AASM 250K-1 in 5)
    approximately 71,000 people
    1,500 deaths

    12.5 billion in
    property losses lost productivity
  • NSF in last year 51 say sleepy 17 have
    fallen asleep
  • Sleep deprivation like driving drunk (blood
    alcohol 0.8)
  • Federal government's "Healthy People" initiative
    aims to reduce the rate of car crashes due to
    sleepiness per 100 million miles traveled from
    2.7 to 2.1 by 2020 Texting?
  • Rumble strips there for a reason! Stop
    immediately, get equivalent of 2 cups of coffee,
    take 20 minute nap 12am 6am risky times

Sleep deprivation consequences long term
  • High blood pressure
  • Heart attack
  • Heart failure
  • Stroke
  • Obesity (diabetes)
  • Cancer
  • Psychiatric problems, including depression and
    other mood disorders
  • Attention Deficit Disorder (ADD)
  • Mental impairment
  • Fetal and childhood growth retardation
  • Injury from accidents
  • Disruption of bed partner's sleep quality
  • Poor quality of life

Obesity and Sleep Deprivation
  • 1/3 Americans obese - calories,
    physical activity, interaction between genes and
    environment and cultural influences
  • Sleeping less is there a connection?
  • Research (2001) Staying awake past midnight and
    lt 6 hrs sleep increased likelihood of

    (2002) A study of 1.1 million people
    found that increasing BMI occurred when
    habitual sleep amounts fell below 7 to 8 hours
    (2004) A study in
    Wisconsin showed that when sleeping less than
    8 hours, the increase in BMI was
    proportional to amount of decreased
    (2005) A
    study done in Virginia showed that overweight and
    obese individuals slept less than
    subjects of normal weight (2005) Short
    sleep duration at 30 mos predicts obesity at 7
  • Since 1992 13 studies of gt 45,000 children
    support inverse relationship messing with the

Taheri, S. Sleep and metabolism Bringing pieces
of the jigsaw together. Sleep Medicine Reviews.
2007. 11159-162
Obesity and Sleep Deprivation
  • 1999 - Spiegel examined sleep restriction and
    effect on metabolism by sleep restricting
    subjects to 4 hrs/night for one week this led
    to impaired glucose tolerance and changes in
    hormones related to weight gain and hypertension
    changes were reversible with normal sleep times
  • 2004 - Spiegel examined effect of sleep
    restriction on hormones related to hunger and
    appetite found that sleep restriction reduced
    hormone leptin (suppresses appetite) by 18
  • It also increased the hormone ghrelin (increases
    appetite) by 28 subjects showed subjectively
    increased appetite for calorie-dense foods with
    high carbohydrate content

Spiegel, K. Impact of sleep debt on metabolic and
endocrine function. The Lancet. October 23, 1999.
3541435-1439. Spiegel, K. et al. Brief
Communication Sleep Curtailment in Healthy Young
Men Is Associated with Decreased Leptin Levels,
Elevated Ghrelin Levels, and Increased Hunger and
Appetite. Annals of Internal Medicine. December
7, 2004. 141846-851
Obesity and Sleep Deprivation
  • University of Warwick Medical School (2006)
  • Capuccio studied 28,000 children, 15,000 adults
  • Sleep deprivation associated with 2-fold
    increased risk of becoming obese
  • Greater in BMI waist circumference over
  • Theory - increase in appetite due to hormonal
    changes from sleep deprivation
  • Lack of sleep produces ghrelin produce less
  • More research necessary

Obesity and mortality
  • Atherosclerosis
  • Heart failure
  • Kidney failure
  • Type 2 diabetes
  • Sleep Apnea
  • Cancer
  • Osteoarthritis

Cardiac Risk
  • Physiological studies at Harvard, Mayo Clinic and
    University of Pennsylvania sleep deficit may put
    body into a state of high alert increasing
    production of stress hormones driving up blood
  • Overall mortality increased but . . . major
    risk factor for heart attacks and strokes sleep
    influences functioning of lining of blood vessels
  • People who are sleep-deprived have elevated
    levels of substances in blood that indicate a
    heightened state of inflammation in the body,
    which has also recently emerged as a major risk
    factor for heart disease, stroke, cancer and
    diabetes hsCRP
  • "Based on our findings, we believe that if you
    lose sleep that your body needs, then you produce
    these inflammatory markers that on a chronic
    basis can create low-grade inflammation and
    predispose you to cardiovascular events and a
    shorter life span" Alexandros N. Vgontzas, Univ
    of PA

Over 1000 studies CV risk, psychosis
  • 2008 University College London/University of
    Warwick UK study of 4,600 men and women aged 35
    to 55, researchers found that women who slept lt 8
    hrs/night had higher risk of dying from CV
    disease than men differences in hormone levels
    may play a role
  • 2007 Mayo Clinic new research shows that getting
    less than 5 hours of sleep a night increases your
    risk of death from cardiovascular disease
  • 2001 Chicago Medical Institute sleep
    deprivation may be linked to more serious
    diseases, such as heart disease and mental
    illnesses including psychosis and bipolar
  • 2007 Harvard Medical School and University of
    California at Berkeley link between sleep
    deprivation and psychosis further documented
    study revealed, using MRI scans, that lack of
    sleep causes the brain to become incapable of
    putting an emotional event into the proper
    perspective and incapable of making a controlled,
    suitable response to the event

Shift work and Cancer
  • Harvard researchers 78,000 females worked
    rotating night shifts over 10 yr period shift
    work significantly increased risk of breast
  • Harvard researchers - same group but those
    working rotating night shift and least 3
    nights/month for 15 years of more had increased
    risk of colon cancer
  • 3rd Harvard team of researchers studied more than
    53,000 women who worked rotating shifts and found
    that night work increased risk of endometrial
    cancer by 47 --- and actually doubled the risk
    of endometrial cancer in obese shift workers
  • World Health Organization (2007) classified shift
    work as a probable cause of cancer ACS will
    continue to research

Mortality associated with sleep duration and
  • Background Patients concern about insufficient
    sleep/chronic insomnia treatment strategies
    guided by how much sleep optimal survival
  • Method In 1982, Cancer Prevention Study II
    (ACS) asked participants about sleep duration and
    frequency of insomnia. Cox proportional hazards
    survival models computed to determine whether
    sleep duration/frequency of insomnia was
    associated with excess mortality up to 1988
    (controlling for demographics, habits, health
    factors, and use of various medications)
  • Results 1.1 M men and women 30 -102 yrs of age.
    survival 7 hrs per night

    8 hrs or gt and 6 hrs or lt experienced
    significantly increased mortality hazard Hazard
    risk gt 15 for some groups (sleeping gt 8.5 hrs or
    lt than 3.5-4.5 hrs) Rx
    sleeping pill use associated with significantly
    increased mortality after control for reported
    sleep durations and insomnia
  • Conclusion Short sleep and insomnia seem
    associated with risk although compares to co
    morbidity risk

Arch Gen Psychiatry. 200259131-136
Mortality associated with sleep duration and
Figure 1. For 636095 women, the average reported
frequency of insomnia, the average number of
sleeping pills used per month, and the mean body
mass index (BMI) according to reported hours of
sleep. The 95 confidence intervals of the BMI
are shown. Also shown are the hazard ratios from
the 32-covariate Cox models and the percentage of
women reporting each sleep duration. The
reference duration of 7 hours is represented by
the lighter bars.
Figure 2. For 480841 men, data comparable to
those shown in Figure 1. BMI indicates body mass
Insomnia, short sleep duration and mortality
  • Random, central PA 1,741 men (followed 14 yrs)
    and women (followed 10 yrs) sleep lab
  • Insomnia complaint for 1 year/Normal absence
    of insomnia
  • Polysomnographic sleep defined normal sleep - gt
    6 hrs short sleep - lt 6 hrs
  • Adjusted for age, race, education, body mass
    index, smoking, alcohol, depression, sleep
    disordered breathing, and sampling weight
  • Mortality rate (2007 U.S. SS Death Index) Men
    Women 5
  • Results mortality rate significantly in
    insomniac men with short sleep
    compared to normal sleep/non-insomniacs when
    adjusted for diabetes, high BP, other
    factors. Women - no
  • Conclusion Insomnia/short sleep in males is
    associated with increased mortality,
    risk that has been underestimated
  • Vgontzas AN Liao D Pejovic S Calhoun S
    Karataraki M Basta M Fernández-Mendoza J
    Bixler EO. Insomnia with short sleep duration and
    mortality the Penn State Cohort. SLEEP

Sleep Debt can we pay back?
  • Sleep debt or deficit - cumulative effect of not
    getting enough sleep large sleep debt may lead
    to mental and/or physical fatigue
  • Two kinds of sleep debt 1) partial sleep
    deprivation or 2) total sleep deprivation
  • Partial sleep deprivation occurs when a person
    sleeps too little for many days or weeks
  • Total sleep deprivation means being kept awake
    for days or weeks
  • Debate in scientific community over specifics of
    sleep debt as a measurable phenomenon
  • 1997 Univ of PA cumulative sleep defect affects
    daytime sleepiness days 1,2, 6 and 7
  • 2003 study different groups tested with variable
    sleep times for 2 weeks
    8 hours

    6 hours

    4 hours

    total depravation
  • Each group in red worsened (by psychomotor
    vigilance task) as time progressed
  • 6 hour group at 10 days - functioning as those
    completely sleep deprived for 24 hrs
  • Negative effects accumulate over time

Sleep Debt
Sleep Aides - hypnotics
  • 25 of Americans use sleeping aide
  • Age 20 44 use doubled from 2000 2004
  • 2 billion on zolpidem (Ambien) in 2004 Global
    5 billion
  • Used to be addictive benzodiazepine (Valium,
    barbiturates (Seconal,
    Halcion and Quaalude)
  • New Lunesta (for longer term use), Ambien CR
    (prevents waking after 4 hours)
  • Most recommended for short term use but abused
  • Risk for nightly use

(No Transcript)
Good news about sleep deprivation
  • Sleep deprivation short term fix for depression
  • Loss of 1 night sleep improves symptoms in 40-6-
    depressed patients
  • One night loss increase in dopamine
  • Not viable for treatment on outpatient basis

Sleep hours trending down National Health
Are you sleep deprived?
  • You dont need a sleep clinic!
  • Do you need an alarm clock to wake up?
  • Falling asleep within 5 minutes of head hitting
  • Napping

Successful Sleep
  • Create sleep chamber
  • Maintain regular bedtime/wakeup time
  • Dont drink fluids before bed
  • Dont work on computer, watch TV or read in
    bed (the 2 Ss only!)
  • Comfortable bed, pillows
  • Exercise regularly
  • Avoid alcohol
  • Avoid caffeine
  • Establish bedtime ritual
  • Dont use tobacco products
  • Dont go to bed until youre sleepy
  • Wake up? Leave bed
  • Spend time outdoors

Sleep Aide

  • Timmer, John. US tossing and turning into a
    sleepless nation 2008
  • Vgontzas AN Liao D Pejovic S Calhoun S
    Karataraki M Basta M Fernández-Mendoza J
    Bixler EO. Insomnia with short sleep duration and
    mortality the Penn State Cohort. SLEEP
  • Marks Psychiatry May 6, 2009
  • Sleep Deprivation Doubles Risks Of Obesity In
    Both Children And Adults Science Daily July 13,
  • Journal of Endocrinology and Metabolism October
    2000 Redwine et al. 85 (10) 3597
  • Wilson JF. In the clinic. Insomnia. Ann Intern
    Med. 2008148(1)ITC13-1-ITC13-16. PubMed
  • Morgenthaler T, Kramer M, Alessi C, Friedman L,
    Boehlecke B, Brown T, et al. Practice parameters
    for the psychological and behavioral treatment of
    insomnia an update. An American Academy of Sleep
    Medicine report. Sleep. 2006291415-1419
  • National Sleep Foundation 2003 Lancet 2002 359
  • http//
  • Schulz H (April 2008). "Rethinking sleep
    analysis". Journal of Clinical Sleep Medicine 4
    (2) 99103. PMC 2335403. PMID 18468306
  • Recognizing the Dangers of Sleep DeprivationBY
  • Spiegel, K. Impact of sleep debt on metabolic and
    endocrine function. The Lancet. October 23, 1999.
  • Spiegel, K. et al. Brief Communication Sleep
    Curtailment in Healthy Young Men Is Associated
    with Decreased Leptin Levels, Elevated Ghrelin
    Levels, and Increased Hunger and Appetite. Annals
    of Internal Medicine. December 7, 2004.

Sleep Deprivation
  • Thanks for your time and attention
  • 913-577-1306
Write a Comment
User Comments (0)