Sleep Deprivation: EMS Enters

The

Dr. Chris Nollette, NREMTP, LP

Mr. Chris Leon, BS, EMTP

Myths or Reality about sleeping?

• You can you bank your sleep

• You only need 8 hours of sleep – no more no less

• You can take a power nap of 20 minutes and restore your activity level

• Sleeping can reduce your waistline

• There is no direct link to Alzheimer's and sleeping

• Sleeping only 4 hours a night can lead to a 70 year old brain by the end of the week

Myths or Reality about sleeping?

• Your are more emotional without sleeping

• Increasing age requires more sleep

• Slap some water on your face, turn the temperature down, sing to the radio, talk to yourself in the car – will keep you awake and alert

Myths or Reality about sleeping?

The Science of Sleep: Under the Bed

• Exxon Valdez – happened after midnight with the man at the helm only getting 4 hours of sleep

• Chernobyl and Three Mile Island – occurred late at night

• Staten Island Ferry crash – exhausted assistant captain

American Cancer Society Study

• 1960 survey asked 1 million Americans how much sleep they were getting each night

• Answer: medium of 8 hours

• Today the medium of 6.7 hours

“Four to six hours of sleep in just six days put one on the road to a pre – diabetic state…contributing to an epidemic of obesity (hormone leptin)”

Eve Van Cauter, endocrinologist University of Chicago School of

Medicine

Sleeping is for the young• Infant – 16-20 hours of sleep a day• Adolescents – 8-12 years of age 10-12 hours• Adolescents – over 12 same as adult 8 hours• Aging – over 65 years – sleep decreases

Kerry Kuehl, MD, Dr.PH, Associate Professor of Medicine

Oregon Health Sciences University

• As we age our time in deep sleep decreases – can some problems of aging be attributed to less sleep?

“We lose deep sleep at a very early age. So a young healthy person may have 100 minutes of deep sleep, and at 50 years old it may be as little as 20 minutes”

Eve Van Cauter, endocrinologist University of Chicago School of Medicine

The Science of Sleep: Under the Bed

REM versus Non REM Sleep

Non REM – 4 stages

Stage 1 Stage 2 Stage 3 Stage 4

Lay down Brain waves Deep Delta

<HR <BP

Tissue / Heart repair

Stage 3 & 4 you may get sleep inertia – hard to get up

The Science of Sleep: Under the Bed

REM versus Non REM Sleep

REM – dream state

Mental health is restored during the night

Medications may knock out REM sleep

and increase depression

Driving yourself to an early grave?...

Effects of Sleep Deprivation on Fire Fighters and EMS Responders

• Study…..Long work hours often are associated with chronic sleep loss, which may result in decreased ability to think clearly, depression, irritability, health complaints, higher body weight, cardiovascular disease and cancer

• Circadian Rhythms – we are day creatures

• Sleeping in another bed – quality of sleep is affected – station or hotel

Effects of Sleep Deprivation on Fire Fighters and EMS Responders

Acute

• Slow reaction time & thinking is impaired

• Reduced psychomotor vigilance

Chronic

• Increased accidents / work related errors

• Chronic sleep deprivation = depression & decrease in sense of well being

Kerry Kuehl, MD, Dr.PH, Associate Professor of Medicine

Oregon Health Sciences University

Effects of Sleep Deprivation on Fire Fighters and EMS Responders

Firefighters and Heart Disease

Leading cause of death over fighting firesNE Journal of Medicine

March 22, 2007

Deep sleep needed for cardiac repair

Averaging less than 6 hours of sleep a night for 6 days is = one pack of cigarettes a day

Kerry Kuehl, MD, Dr.PH, Associate Professor of Medicine

Oregon Health Sciences University

Effects of Sleep Deprivation on Fire Fighters and EMS Responders

ObesitySleep loss = weight gain

Kerry Kuehl, MD, Dr.PH, Associate Professor of Medicine

Oregon Health Sciences University

CancerMeta analysis of 32 studies showed an increase in

testicular, prostrate & lymphomas Journal of Occupational & Environmental Medicine

November, 2006

World Health Organization study on night shifts for nurses and firefighters – increase in colon, prostate, and breast cancer

Lancet, OncologyDecember 7, 2007

Sleep and our Mental Health

• Mood swings common: short tempered and giddy within seconds

• Hyperactive brain

• Disconnect between the amygdala and the frontal lobe

Brain scans look similar between those with a lack of sleep and those with a psychiatric disorder

Matthew Walker, Director Sleep and Neuroimaging Lab University of California, Berkeley

Sleep and our Memory

• Sleep enhances memory

• Study subjects participated in a sleep research and memory study

• Students did 40% worse on memorization after being up for 24 hours without sleep

Matthew Walker, Director Sleep and Neuroimaging Lab University of California,

Berkeley

Driving Drowsy: Micro-sleeping at the wheel

• 241 volunteers agree to have their cars wired with five cameras each

• Over one years time the study found that driving drowsy (micro-sleeping) was the riskiest behavior of all

Virginia Tech’s Transportation Institute

NIH funded study at the University of Pennsylvania’s School of Medicine

• Chronic partial sleep deprivation

• Stay awake till 4 a.m. then woken up at 8 a.m.

• Findings: cumulative impairment• First night – thinking and memory slows down• Second and third night – deficit to cognitive ability

• No bright lights or caffeine allowed – the counter measures

Epworth Sleepiness Scale

Never dose off > Doze off• Sit and read 0 1 2 3• Watch TV 0 1 2 3• Sit and talk 0 1 2 3• Ride in car0 1 2 3• Lying down 0 1 2 3• After lunch0 1 2 3• Sitting traffic 0 1 2 3• This talk 0 1 2 3

Where are you at?…low number? Maybe your safe

Obstructive Sleep Apnea (OSA)

Oh….the number is only one measurement!

• Score greater than 16 on the Epworth Scale

• Snore

• Fatigue related crashes

• Overweight or Obese

• Greater than 17 inch neck

• Increased blood pressure

Myths or Reality about sleeping?

• You can you bank your sleep

• You only need 8 hours of sleep – no more no less

• You can take a power nap of 20 minutes and restore your activity level

• Sleeping can reduce your waistline

• There is no direct link to Alzheimer's and sleeping

• Sleeping only 4 hours a night can lead to a 70 year old brain by the end of the week

Myths or Reality about sleeping?

• Your are more emotional without sleeping

• Increasing age requires more sleep

• Slap some water on your face, turn the temperature down, sing to the radio, talk to yourself in the car – will keep you awake and alert

Myths or Reality about sleeping?

Do we hide under the bed?• Health lifestyle changes – Sleep, diet and

exercise

• Do we really want 24 / 36 or 72 hour shifts?

• Cool, quite, dark place with no stimulants

• Naps <20 minutes or > 90 minutes

• Limit alcohol and caffeine

What is the alternative?...........

The End ….or is it?

Sleep well …. Sleep tight…. We thank you for letting us be a part of your day