Dr. Colin M ShapiroMBBCh, PhD, MRC Psych. FRCP(C)
Professor, Department of Psychiatry and Opthalmology
University of Toronto
Director, Sleep and Alertness Clinic
Youthdale Child & Adolescent Sleep Centre
Adam and Oswald: Clinical Science 1983, 65, 561
In nocturnal animals peak rates of RNA and protein synthesis, RNA and protein content of cells, number of cells and growth rates occur at the time when sleep predominates i.e., during the light period.
**Each star represents a published report
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Activity Period Sleeping Period
1800h 2400h 0600h 1200h 1800h
LIFE - Cycle and SleepComposition of SleepComposition of Sleep
16
14
12
10
8
6
4
2
REM
DEEP
LIGHT
Newborn16 hrs. avg.
Young Adult8 hrs. avg.
Adult7 hrs. avg.
Elderly6 hrs. avg.
50%
25%
24%
1%
26%
19%
53%
2%
18%5%
62%5%
WAKE
25%
11%
61%
3%
INSOMNIA Difficulty Falling asleep Can’t Stay asleep (keep waking up) Wake up too Early in the morning Sleep is not Refreshing
Can affect up to as many as 1 in 5 teens Signs: always Fatigued; Drinking too much Caffeine; Inattention; Irritable; Lack of Get-up and Go
Melatonin
• secreted by the pineal gland • melatonin is produced to help our bodies
regulate our sleep-wake cycles • Darkness stimulates the release of melatonin
and light suppresses its activity • melatonin cycles are disrupted when we are
exposed to excessive light in the evening or too little light during the daytime
• Difficulty with sleep onset at desired time• Once initiated, sleep is normal• Most common CRSD referral• Population data lacking
• Population estimates of prevalence of 0.17 – 0.25%• Prevalence increases to >15% amongst adolescents• Insomniacs: 10%• Positive family history
19 21 Midnight 3 6 9 Noon
Normal Sleep Phase
DSPD
Phase ADVANCE
Melatonin “pulls” sleep time forward
Light “pushes” it away/forward
Rahman, Kayumov,Casper & Shapiro
• Patient with phase delay are more likely to develop depression!
• 2010
School-related Symptoms of Youth Depression
• Poor performance in school, truancy, tardiness• Withdrawal from school activities/peer groups• Lack of enthusiasm, energy or motivation• Globalized anger and rage• Overreaction to criticism, increased self-criticism• Indecision, lack of concentration or forgetfulness• Restlessness and agitation• Problems with authority• Suicidal thoughts or actions (e.g., cleaning out
locker, giving away items)
• Fear of failure• social rejection• bodily sickness• bullying or abuse• childhood memories• thoughts of a better life• separation with family• worries about the future
• This booklet was distributed to parents, school boards, family doctors, group practice and social workers .
• Response was positive and helped families in particular to accept the diagnosis and initiate treatment specifically.
• Parents and health professionals were able to recognize the behavior in the children after reading this booklet.
• This educational tool also helped in the early recognition, detection and assessment of depression in children and teenagers at the sleep clinic.
• Active investigation into markers of circadian phase in humans
• Two currently utilized markers• Core body temperature• Dim light melatonin onset (DLMO)
Mel
ato
nin
(p
g/m
l)
Time of Day
• Increase in levels begin between 6:00 pm & 9:30 pm (DLMO)
• Levels peak approximately 3:00 am & begin to decrease
• Lowest levels just before awakening
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