Sleep and Sleeping Well - Dr Linda Schachter Sleep & Respiratory Physician

Sleep and Sleeping Well
          Dr Linda Schachter
     Sleep & Respiratory Physician

What are YOUR key questions
  or problems on sleep ?

Overview

1.   Sleep basics
2.   Sleep deprivation
3.   Trouble sleeping
4.   Getting good sleep

SLEEP BASICS

Why do we need sleep ?
• Sleep is a dynamic behavior. Not simply the absence of waking,
sleep is a special activity of the brain, controlled by elaborate and
precise mechanisms.
–   Rest and Recharge
–   Aid memory and learning
–   Hormone secretion
–   Maintain normal immune function
–   Healing and repair of tissues
–   Maintain optimal emotional and social functioning while awake

Sleep Stages

Rollercoaster of sleep

                         7

Differing types
of sleep across
    the ages

Circadian rhythms

Our circadian rhythm tell us when
we are sleepy and when we sleep best

• Melatonin rise delayed with
  puberty

• Adolescent monkeys also
  delay melatonin rise with
  puberty

• Blue computer screens
  suppress melatonin

‘Orange’ substitute:

• ‘Nightshift’ Iphone iOS 9.3
• F lux program for PCs
  http://justgetflux.com/

When we sleep also determined by …

Sleep drive

                              Stress/
                              hyperarousal

SLEEP DEPRIVATION

How much sleep do we need?

•   The amount that allows us to be wide awake, alert and
    energetic throughout the day
•   The average sleep need for an adult is about 8-9 hours (range
    4-10 hours)
•   The specific value varies considerably from person to person
    and may be a genetically determined attribute.
•   Amount required decreases over life cycle

Lack of sleep - causes
– Lifestyle
   •   Late bed time
   •   Habits
   •   Sporting commitments
   •   Phone / computer
   •   Work
   •   Children
– Health
   • Pain
   • Sleep disorders – snoring, sleep apnoea, insomnia,
     restless legs
   • Medication
– Psychological - depression / anxiety / stress
– Environmental - noise / light / travel
– Shift work

The statistics…

• 4 in 10 Australian adults – 7.4 million frequently suffer
  from inadequate sleep
   – 1.1 million – sleep disorders like insomnia & sleep apnoea

   – 2.5 million with health problems that affect sleep

   – 3.8 million routinely fail to get enough sleep

Likely if

v Still tired when wakes in the morning

v sleeping less than 9 hours a night

v sleeping in on the weekends

v still groggy on way
  to school

v sleepy after lunch

Partial sleep deprivation
                  (effects on school work)
–   Hard to think
–   Hard to concentrate
–   Poor complex problem solving
–   Poor memory
–   Poor visual and spatial abilities
–   Less creativity

Get a good sleep to help learning
Get a good sleep before exams

Partial sleep deprivation
          (emotional effects)

– More mood swings
– More chance of depression
– Easily irritated
– Less able to handle stress
– More quickly aggressive

  Get a good sleep to be in control emotionally

Partial sleep deprivation
         (physical effects)

– Less immunity

– Increases likelihood of weight gain

– More physical injuries in sport

       Get a good sleep to stay well

TROUBLE SLEEPING

Many different reasons

                         Trouble:

                         q Going to sleep

                         q Staying asleep

                         q Waking too early

                         OR Feeling unrefreshed

Poor sleep is often more to do with
what happens when awake than
        when trying to sleep

Anxiety / Stress and sleep

– Heightened cortical and peripheral arousal (cf sleep -
  restorative state of diminished cortical arousal)
– Problems with sleep initiation, maintenance and structure
– Sleep that is restless and unsatisfying
– Fatigue and irritability (may be due to sleep loss)

Anxiety / Stress

• Biggest cause of poor sleep

• Your thoughts can stress you
  Are your thoughts realistic?

• Share stressful thoughts

• What relaxes you? Try to do it everyday

Am I awake or asleep?

• Easy to mix up

• Mind keeps going in sleep

• More aware of mind if stressed

• Anxiety slows time

• Most poor sleepers get more sleep than they think

Even dozing in bed is good

GETTING GOOD SLEEP

Healthy Sleep Habits
 •   Sleep schedule
 •   Sleeping environment
 •   Pre-bed routine
 •   Bed is for sleep
 •   Go to bed when tired
 •   Avoid stimulants
 •   Daytime exercise
 •   Alcohol
 •   Nicotine

Sleep environment - Bedroom

                                   More electronic devices in
                                   bedrooms = less sleep

– Comfortable mattress / pillow
– Cool - Don’t overheat with
  heavy bedclothes
– Quiet - Reduce noise
– No disturbances e.g. pets
– Dark
– Feel secure (night light?)
– No clock if clock watch
– Leave curtains open if needed
– Consider app of white noise or
  rain

Daytime / Lifestyle

–   Routine sleep/wake times
–   Avoid sleeping in (no more than one hour extra on weekends)
–   Morning bright light
–   Long naps can be a problem

– Exercise
– Moderate alcohol, if any
– No Nicotine

– Have a ‘worry time’
…complete a ‘constructive worry sheet’

Pre bedtime routine - Evening
   • Have one hour ‘wind-down time’ before bed
   • e.g. music, bath, TV, magazine, chatting or novel
   – not school-work and not computers

• Breathing exercises (Breathe2Relax app)
• Mindfulness (Smiling Mind / headspace app)

   • No caffeine after 4pm
   • No late heavy meal
   • Avoid late major exercise
   • Don’t fall asleep before bedtime,
      not even for a minute
   • Avoid close screens

Bedtime routine

§ Get ready for bed in good time
§ Consider warm milk drink or herbal tea
§ Think positively about getting into your snug, calm bed

Wait for a wave of sleepiness before trying to sleep

In bed

§   Turn off the mobile phone
§   Feet not too hot or too cold
§   Attitude is important
§   Think ‘feel good’ statements
§   Slow down your breathing
§   Exercise the imagination…create a story
§   Calm music may be Ok

Can’t make yourself fall asleep
Make your ‘worry time’ earlier in the day
Bed is not the place to think about school work

If wide awake and frustrated get out of bed and do something
    else for while

•   Don’t give up quickly….be persistent… don’t expect
    perfection

•   The more relaxed you are about moving between sleep,
    wake and dozing the better your sleep will become

In conclusion….

– Sleep is as important as food and water
– Sleep deprivation / sleep issues are prevalent and affect
  mood, memory, health & weight
– Everyone can improve their sleep
– If getting enough sleep and still tired, important to see
  your doctor

For more information about sleep

www.sleephealthfoundation.org.au
Click on Information Library/Fact Sheets A - Z

  Examples:
  qAnxiety and sleep
  qDepression and sleep
  qGood Sleep Habits
  qInsomnia
  qNapping
  qSnoring
  qUnderstanding and Helping Poor Sleep

Consider seeing a doctor…
•      Have trouble getting to sleep or wake up frequently during the
    night for a period of several weeks
•      Waking up tired despite getting enough sleep
•      Fall asleep at inappropriate times even after a night of
    adequate sleep
•      Have nightmares or night terrors (the experience of awakening
    in a terrified state without recollection of a dream) that interrupt
    your sleep
•      Sleep-walk
•      Have been told by someone that you stop breathing during
    sleep, especially if you have morning headaches or fall asleep
    easily during the day