1. Sleep and Sleep Disorders: A Public Health Concern in Europe Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 1. European Sleep Research Society (ESRS) 2. What do we know about sleep? 3. People in modern society sleep less than needed 4. Insufficient sleep and sleep disorders are a social and health problem 5. What can we do?

2. 1. European Sleep Research Society (ESRS) Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011

3. 1. European Sleep Research Society (ESRS) Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Established in 1971  Established in 1971 Aims  Aims to promote sleep research, sleep medicine and education on sleep in Europe Membership  Membership approximately 1000 full members and 7000 associated members Fields of interest  Fields of interest neuroscience, physiology, psychology, pharmacology, neurology, psychiatry, pulmonary medicine Assembly of the National Sleep Societies  Assembly of the National Sleep Societies ESRS is connected to the National sleep societies of 27 European countries in a federal-like structure Conferences and events  Conferences and events biannual congress (Paris 2012) – teaching courses and training initiatives

4. 2. What do we know about sleep ? we know that performance and skills are deeply impaired after sleep loss, but we still don’t know which the substrates of this impairment are at brain level we have some knowledge about brain circuits and mechanisms underlying sleep, but we still don’t know how to manipulate them properly in order to normalize sleep on long-term basis Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Sleep is a fundamental biological function, but we still don’t  Sleep is a fundamental biological function, but we still don’t know what sleep is for know what sleep is for

5. 3. People in modern society sleep less than needed  Modern lifestyles and modern working environments promote the development of sleep problems Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Insomnia Insomnia is the most prevalent sleep disorder in Western societies with approximately 10% of the population suffering from it chronically the development of technology shift-work and irregular working hours (20% of the workers !!) working stress are major determinants in the development of sleep disturbances and chronic sleep loss

6.  Insufficient sleep impairs working and driving safety 4. Insufficient sleep and sleep disorders are a social and health problem Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 attention, reaction times, memory and motivation, deteriorate with insufficient sleep after 24 hours awake, performance is compromised as badly as under the influence of 1 g/L BAC* (blood alcohol concentration) * BAC after drinking approximately one bottle of wine in 1 hour

7.  Insufficient sleep impairs working and driving safety 4. Insufficient sleep and sleep disorders are a social and health problem Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 sleeping less than 5 hours/night increases the accidents rate up to for 4.5 times sleepiness and sleep-related problems determine 20% of road accidents the fatigue of a critical person has been shown to contribute to several major industrial and traffic catastrophes during the last decades Chernobyl 1986 Three Mile Island 1979 Shuttle Challenger 1986 Exxon-Valdez 1989 Tunnel St. Gotthard 2001

8.  Insufficient sleep and sleep disorders can have severe consequences on general health Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Obstructive sleep apnoea (OSA) (which now is present in 4% of European males and 2% of females) is the most common organic sleep disorder causing excessive daytime somnolence OSA is a risk factor for hypertension, coronary artery disease and heart failure and plays a role in sudden cardiovascular death The risk of cerebrovascular disease is higher in patients with severe OSA than in the general population 4. Insufficient sleep and sleep disorders are a social and health problem

9.  Insufficient sleep and sleep disorders can have severe consequences on general health Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Both sleep deprivation and insomnia are linked to increased incidence of hypertension, cardiovascular morbidity and coronary events: short sleep duration increases the risk for future coronary artery disease insufficient sleep has been also recently shown to represent a risk factor for diabetes or obesity, which, in turn is the most important predisposing factor for obstructive sleep apnoea (OSA) 4. Insufficient sleep and sleep disorders are a social and health problem

10.  Insufficient sleep and sleep disordersare associated with major neuro-psychiatric disorders  Insufficient sleep and sleep disorders are associated with major neuro-psychiatric disorders Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Insomnia, hypersomnia or both are reported by 75% of adults, children, and adolescents with major depressive disorder Insomnia and hypersomnia are associated with an increased (ten-to fifteen-fold) risk for the development or recurrence of major depressive disorder and bipolar disorder Sleep disorders are associated and can even predict the occurrence of dementia or parkinsonism 4. Insufficient sleep and sleep disorders are a social and health problem

11.  Insufficient sleep and sleep disorders are expensive Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 the direct costs of insomnia have been estimated to be 2.5 billion dollars/year in the USA, while the indirect costs of this condition can be as high as 100 billion dollars/year in 2009, traffic accidents caused in the USA by sleep apnoea alone cost 15.8 billion dollars, as well as 1400 lives respective calculations for Europe are not currently available, but, a similar economic burden is reasonably assumed 4. Insufficient sleep and sleep disorders are a social and health problem

12. 5. What can we do?  Educating more scientists and professionals to deal with the increasing demands incurred by sleep disorders education should be the core and basis of every effort to improve the field there is a need for more sleep specialists in the near future there is a need for funding to organize more training and teaching events there is a need to recognise sleep medicine as a medical speciality to facilitate training and increase the number of sleep specialists in all European countries Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 168 young sleep researchers from 34 different countries were trained in the Program ESRS - EU “Marie Curie” Project 2007-2010 Training in Sleep Research and Sleep Medicine

13.  Increasing scientific research on sleep and its disturbances about 130 centres are active in the field of basic and clinical sleep research in 27 different European Countries 5. What can we do? Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 European sleep research is of an internationally very high standard both in clinical and basic research themes, however, in terms of coordinated power and structured funding, we unfortunately still lag considerably behind the USA more research should be funded and performed to better understand sleep mechanisms and functions, and to address the effects of sleep loss on health and sleep loss as a health risk factor

14. Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 5. What can we do? Increasing tools and knowledge to improve the diagnosis  Increasing tools and knowledge to improve the diagnosis and scientifically sound treatments for sleep disorders and scientifically sound treatments for sleep disorders Presently, at the European level, there is a defect of high-quality resources to treat patients with sleep disorders even in well- developed countries Furthermore, the large gap between well- developed countries and less developed areas (e.g. Baltic and Balkan countries) in terms of high-quality resources needs to be closed

15. Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 5. What can we do?  Establishing: common European guidelines for the diagnosis and treatment of sleep disorders common European legislation regarding working schedules on the 24-hour cycle (especially working at night) and limitations of working hours in safety-sensitive professions “Sleep Medicine” as a medical speciality Europe wide

16.  Increasing the awareness of the importance of sleep and the health consequences of sleep loss among the general public Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 5. What can we do?

17.  Increasing the awareness of the importance of sleep and the health consequences of sleep loss among the general public Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 5. What can we do? Portuguese “Sleepiness at the wheel 2011” Campaign The Portuguese Sleep Association has undertaken an important campaign with the support of the Portuguese Ministry of Internal Affairs, the local government in Lisbon and the National Road Safety Association. “Sleepiness at the wheel can kill“

18. Thank you for your attention and support…….!! Meeting of the ESRS with the EU Commissioner for Health and Consumer Policy Brussels, December 15th 2011 Claudio Bassetti (Lugano/Bern, Switzerland) President of the ESRS Roberto Amici (Bologna, Italy) Chair of the ESRS EU Committee Diego García Borreguero (Madrid, Spain) Co-Chair of the ESRS EU Committee Marta Gonçalves (Oporto, Portugal) Member of the ESRS EU Committee