Presentation on theme: "Academy Of Medicine Clinical Day, February 24, 2012"— Presentation transcript:
1 Sleep: The Golden Chain That Ties Health and Our Bodies Together (A Review of Sleep Disorders) Academy Of Medicine Clinical Day, February 24, 2012Elliott K. Lee MD, FRCP(C), D. ABPN,D. ABPN Addiction Psychiatry, D. ABSMAssistant Professor, University of Ottawa Faculty of MedicineSleep Specialist, Royal Ottawa Mental Health Center Sleep Disorders Clinic
2 ObjectivesDescribe the importance of sleep and impact of sleep disorders in the community.Understand common sleep disorders and how they can be assessed and treated.
3 Outline Review sleep architecture, and how sleep is controlled. Review insomnia and excessive daytime sleepiness, and their causes
4 SLEEP NREM Sleep REM Sleep Stage N1, N2 (“Light sleep”) procedural memory (skills, motor learning)Stage N3 Deep or “Slow Wave Sleep” (SWS)CNS restoration Declarative memoryREM SleepDreaming Mood Regulatory Role? Memory?
5 Sleep Hypnogram REM occurs more in the 2nd half of the night Slow wave (stage 3-4, deep sleep) occurs in the 1st half
7 InsomniaAffects 3.3 million Canadians (1/7) according to Statistics Canada (2002)Especially: - Middle aged (45-64) - Widowed - Minimal education - Obese - Women > men
8 Treating Insomnia: Personal Sleep Hygiene Maintain a regular wake/sleep schedule, possibly add mild sleep restriction.Refrain from taking naps.Exercise - but not within 3 hours of bedtime.Establish a relaxing routine before bedtime.Use the bedroom only for sleep activities.Avoid clock watchingSet environment (light, noise, temperature) at comfortable levels.Avoid caffeine after mid-afternoon.Talk about adenosine – accumulates – helps us sleep – why exercise may be helpful for sleep
10 Eszopiclone Sleep Latency Sleep latency from ave = 70 min Placebo = 45 min Eszopiclone = 27.3 minTotal Sleep TimeTotal Sleep TimePlacebo = 330 min Eszopiclone = 390 minEszopiclone users had improved quality of life, and no reported incidence of tolerance or withdrawalWalsh et al, Sleep, 2007
11 Obstructive Sleep Apnea (OSA) Pauses in breathing > 10 seconds in lengthRespiratory Disturbance Index (RDI): >5 hr = significantPrevalence – up to 25% of men, and 9% of womenKey diagnostic questions: - Do you feel satisfied with the quality of your sleep? - Does your partner complain that you snore?
12 Obstructive Sleep Apnea Syndrome Symptoms Snoring >80% *up to ½ of pts may sleep separately from partnersApneic episodes (partner) 75%AM Dry Mouth 74%Restless Sleep/ AM H/A 50%Sensation of choking %Nighttime bathroom visits 28%Kryger, Roth and Dement, Principles and Practice of Sleep Medicine, 2005 p. 1043
13 OBSTRUCTIVE SLEEP APNEA (OSA) Causes▪ Narrow Upper Airway▪ Elevated BMI▪ Family HxExacerbated by:▪ Medications – muscle relaxants, sedatives▪ Alcohol Consumption▪ Supine sleep▪ REM sleep▪ **Supine + REM sleep
19 Atherosclerosis and Hypoxemia? Savransky and colleagues studied mice – divided into 4 groups:*Savransky V et al Am J Respir Crit Care Med, 2007Intermittent Air (Control)10Chronic Intermittent HypoxemiaRegular dietHigh Cholesterol diet
20 Atherosclerosis and Hypoxemia? Which ones developed atherosclerosis?*Savransky V et al Am J Respir Crit Care Med, 2007Intermittent Air (Control)Chronic Intermittent HypoxemiaRegular dietHigh Cholesterol diet9
21 Atherosclerosis and Hypoxemia? Sections of aorta from the mice:*Savransky V et al Am J Respir Crit Care Med, 2007Intermittent Air (Control)Chronic Intermittent HypoxemiaRegular dietHigh Cholesterol diet
23 Fatal CV events and OSAMonthsMarin JM et al. Lancet, 2005
24 Nonfatal CV events and OSA Marin JM et al. Lancet, 2005
25 Sleep and Mental Illness OSA can exacerbate mental illness: - Aggression /cognition in schizophrenia - Depression - Nightmares in PTSD - Cognitive dysfunction in dementias - Relapse to substance abusePsychiatric illnessSleepLee EK and Douglass AB. Can J Psychiatry, 2010; 55(7):
33 Restless Legs Syndrome NB- symptoms WHILE AWAKE“URGE”U – rge to move legsR – est – symptoms worsened at restG – ets better with movementE – vening – symptoms worse in eveningOften associated with periodic limb movements (PLMs), WHILE ASLEEP
34 Epidemiology – RLS Affects 5-15% of the population Mean age – years old - prevalence increases with age - age of onset varies widely (children – elderly)Up to 2.5X more common in women
35 Restless Leg Syndrome + PLMD Thought to be related to same problem – dopamine deficiency in the brainMay be exacerbated by caffeine, nicotine, alcohol, or iron deficiencyMainstay of treatment - Dopamine replacement therapy - levodopa, pramipexole, ropinirole - Other meds may also help - neurontin, benzodiazepines, opioids
36 NarcolepsyA pathologic disorder of sleepiness during the day – key symptom – sleepinessMay have insomnia at nighttimeAffects about 1/2000 peopleVery underdiagnosed; difficult to recognize80% may have cataplexy, a REM sleep intrusion phenomenon on wakefulnessRelated to cerebrospinal fluid deficiency of hypocretin (orexin)
38 SummarySleep has a distinct architecture and is normally regulated by a complex set of environmental, biological and social influencesInsomnia and excessive daytime sleepiness are common issues among patientsIf sleep is problematic, assessment for an underlying sleep disorder such as obstructive sleep apnea, restless legs syndrome, narcolepsy or others is important, as effective treatments are available for these conditions
39 Screening Questions For Symptoms Of Poor Sleep Do you feel satisfied with the quality of your sleep?Does you partner complain about your sleep?Do you have difficulties falling or staying asleep?Do you have problems with sleepiness during the day?