Melbourne Sleep Disorders Centre Sleep Dr David Cunnington, Sleep Physician MBBS MMedSc(Clin Epi)...

Melbourne Sleep Disorders Centre

Sleep

Dr David Cunnington, Sleep PhysicianMBBS MMedSc(Clin Epi) MAppMgt RPSGT RST FRACP FCCP FAASM



What does a sleep doctor do?


Look after people with sleep problems

• Can’t get to sleep or stay asleep• Feeling tired all the time• Sleep walking / talking / eating• Working shift work• Nightmares / bad dreams• Snoring• Restless legs


Monitor people while they are sleeping


Teach people about good sleep


Conduct sleep research


Sleep Research

• What time do turn lights out?• How long are you in bed before lights out?• How long do you sleep for?• How many times do you wake up?• What time do you get up in the morning?


What time do turn lights out?

• 7:30-7:59• 8:00-8:29• 8:30-8:59• 9:00-9:29• 9:30-10:00• After 10:00

7:30-7:59 8:00-8:29 8:30-8:59 9:00-9:29 9:30-10:00 After 10:000

5

10

15

20

25

30

0

10

25 24

10

0


How long are you in bed before lights out?

• Less than 10 min• 10-19min• 20-29min• More than 30 minutes

<10 10-19 20-29 >300

5

10

15

20

25

30

35

40

35

9

1611


How long do you sleep for?

• Less than 8 hours• 8 – 8 ½ hours• 8 ½ - 9 hours• 9 – 9 ½ hours• 9 ½ - 10 hours• 10 -10 ½ hours• 10 ½ -11 hours• More than 11 hours

<8 8-8.5 8.5-9 9-9.5 9.5-10 10-10.5 10.5-11 >110

2

4

6

8

10

12

14

8

5

12

9

13

11

7

2


How many times do you wake up?

• 0-1• 2• 3• 4• 5• 6• More than 6

0 or 1 2 3 4 5 6 >60

10

20

30

40

50

60

50

4 5 3 1 2 1


What time do you get up?

• 6:00-6:29• 6:30-6:59• 7:00-7:29• 7:30-7:59• 8:00-8:29• After 8:30

6:00-6:29 6:30-6:59 7:00-7:29 7:30-7:59 8:00-8:29 After 8:300

5

10

15

20

25

30

11 12

19

27

7

1


What is good sleep?


What is good sleep?• Experience

– Unaware of things around us• Observer

– Quiet, eyes closed, doesn’t respond• Neurophysiological

– Slowing of brain waves• Functional

– Have enough energy to do what we want to do


What is normal sleep?


Experience

• 7/10ths of the night (70%)– Unaware of things around us– Still

• 3/10ths of the night (30%)– Can hear things and be aware of things– Restless

• 10 hours of sleep• 1-2 awakenings


Sleep changes as we get older

Newborn: 15-16 hoursPre-school: 14 hoursKindergarten: 12 hoursPrimary School: 10-11 hoursHigh School: 9 hoursUniversity: 8 hoursParent: 7.5 hoursGrandparent: 7 hoursGreat grandparent: 6.5 hours


Kripke et al 2001

We all have different sleep needs


Time (hrs)

Sleep Drive

16 8

Sleep debt


Time (hrs)

Reduced sleep time – 1 night

Sleep Drive

18 6

6 hours of ‘wake’


Time (hrs)

Sleep Drive

18 6 18 6 1818 6 6

16

24

36

Reduced sleep time – 4 nights


What happens when we don’t get enough sleep?


‘The early bird gets the worm’


Most people feel tired on waking

Jewett et al. (1999)

• It can take up to 2 hours to reach full alertness upon

awakening.

• It can take even longer before we are functioning at

our peak.


Delayed phase in teenagers

0600 1400 2200 06001400 2200


Dreams• Non-REM dreams

– Things that are recent (in the last week or so)

– Think about them over and over• REM dreams

– Strange things that we may not have put together before

– Can be pleasant or scary


Stage 1 sleep (sleep wake)• Drifting off to sleep

– Can be aware of muscles relaxing• Feels like falling

– Can get muscle jerks or twitches– Still wake easily if someone talks to us– May not realise we have been asleep

• Usually lasts 5-10 minutes• Each time we go in or out of sleep


Stage 2 sleep• Asleep but

– Can still have awareness of things around us

– Have non-REM dreams– Can have restless movements

• Usually about half of the night


Stage 3 sleep (deep sleep)• Deeply asleep

– Unaware of things around us– If woken

• Not sure where we are• Confused• Can take a while to wake up

• More in the first few hours of the night


REM sleep (dreaming sleep)• Deeply asleep

– Unaware of things around us– Dreaming

• Sometimes can remember dreams after waking but unless write them down, can forget

• More towards the end of the night


Sleep stages

Stage 4

Stage 3

Stage 2

Stage 1

REM

Awake

24:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00

Time (h)

Non-REMREM


Good sleep habits


Bedroom• Suitable for sleeping

– Quiet– Dark– Temperature 15-20 degrees

• Bed– Laying flat– 1 pillow best– Covering to regulate temperature


Good sleep habits?


Getting ready for sleep• Have a routine

– Preparing for bed at a regular time each day

• brush teeth / pyjamas on– In bed

• Read / relax

• Avoid over-stimulation– Excitement / light

• Familiar object / routine– Even adults have ‘teddies’


Good sleep habits?


During night• If wake up

– Familiar object or routine• Avoid trying to go to sleep

– Aim to rest comfortably – sleep will come– Can distract yourself

• Imagine your favourite place

• Don’t do Sleep Maths– “It’s only 6 hours until my alarm goes and

I’ve only had 2 hours sleep so I need to get back to sleep soon to get 8 hours of sleep”


In the morning• Give the body signals that it’s time to

wake up– Light– Movement– Noise


Sleep problems


Sleep walking / talking

• Almost all 5 year olds– Especially when more tired

• 2 in 100 adults (2%)

• Can be:– Talking / walking / eating / driving

• In children goes away as get older• In adults, if causing problems, see

doctor


Nightmares / night terrors

• Very common in early primary school children

• Can wake suddenly very scared

• In children goes away as get older• In adults, if causing problems, see

doctor


Snoring and sleep apnea

• 1 in 4 adults have loud snoring• 1 in 20 adults stop breathing while

sleeping

• If stop breathing can cause:– Feeling tired & grumpy– High blood pressure

• See a doctor to have a sleep test


Summary

• Getting enough sleep is important for our health

• We need to:– Have a suitable place for sleep– Maintain a regular bed-time and routine– Avoid over-stimulation before lights out– If we wake at night, don’t try to sleep or

worry about sleep


Sleep

Dr David Cunnington, Sleep PhysicianMBBS MMedSc(Clin Epi) MAppMgt RPSGT RST FRACP FCCP FAASM


Melbourne Sleep Disorders Centre Sleep Dr David Cunnington, Sleep Physician MBBS MMedSc(Clin Epi)...

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