1. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleepless in Swannanoa

2. Copyright © 2001 by Harcourt, Inc. All rights reserved. Main Point and Primary Problem: Sleep has a strong impact on our waking life: from mood to alertness to learning to safety to health… Sleep has a strong impact on our waking life: from mood to alertness to learning to safety to health… Yet, we treat sleep as a luxury rather than as a necessity. Sleep as a necessity

3. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleep Facts Adult sleep need is ____ per 24 hours, with little variability (homeostatic “set point”) in an individual Impairment in performance occurs with as little as two hours less per night Sleep debt from restricting sleep to 5-6 hours a night accumulates with time Circadian timing has a major impact on performance – especially in certain occupations (e.g., shift work), but also in our normal daily sleepiness/wakeful rhythms

4. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleep Facts Sleep is an interplay between: Internal biological clock (circadian rhythms), and External factors (e.g., light/dark cycles, sociocultural factors) e.g., Delayed sleep phase disorder in teens & college students

5. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleep’s demand… Sleep is mediated by central nervous system: With accumulating sleep debt, we show the signs of impending sleep – yawns, head nods, eye- rubbing…

6. Copyright © 2001 by Harcourt, Inc. All rights reserved. Stages of Sleep

7. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleep architecture

8. Copyright © 2001 by Harcourt, Inc. All rights reserved. How much do we need and why do we need it? Reference: NSF

9. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleep as restorative Sleeping brain is active: Regulates immune and endocrine functions essential for general health

10. Copyright © 2001 by Harcourt, Inc. All rights reserved. Chronically Sleep Deprived...  The average American sleeps fewer than 7 hours  37% of adults say they are so tired during the day it interferes with daily activities  74% of adults experience symptoms of a sleep disorder a few nights a week or more  Just one in five adolescents gets an optimal nine hours of sleep on school nights (High school seniors – 6.9 hrs/nt)  College students – 6.1 hrs/nt NSF Sleep in America Poll

11. Copyright © 2001 by Harcourt, Inc. All rights reserved. Are You Sleep Deprived? 1. I need an alarm clock in order to wake up at the appropriate time. 2. It’s a struggle for me to get out of bed in the morning. 3. Weekday mornings I hit the snooze bar several times to get more sleep. 4. I feel tired, irritable, and stressed out during the week. 5. I have trouble concentrating and remembering. 6. I feel slow with critical thinking, problem solving, and being creative. 7. I often fall asleep watching TV. 8. I often fall asleep in meetings or lectures or in warm rooms. 9. I often fall asleep within five minutes of getting into bed. 10. I often feel drowsy while driving. 11. I often sleep extra hours on weekend mornings. 12. I often need a nap to get through the day.

12. Copyright © 2001 by Harcourt, Inc. All rights reserved. Sleep Deprivation Are WWC students sleep deprived? Sample: 202 students 6.9 hrs/nt 29% get 6 hours or less 2 out of 3 get 7 hours or less 25% feel either “very” or “extremely” tired in the morning

13. Copyright © 2001 by Harcourt, Inc. All rights reserved. Consequences of Sleep Loss Behavioral/Mood Sleepiness / Microsleeps Psychomotor Impairment Accidents Decreased Work Productivity Reduced Quality of Life Mood Effects Deficits in Learning and Memory Lack of Awareness/Concentration Substance Use / Abuse Physiological Immuno-compromise Insulin Resistance Increase in stress hormones Blunted Arousal Response (EEG)

14. Copyright © 2001 by Harcourt, Inc. All rights reserved. Effects on health: Institute of Medicine Report “The cumulative effects of sleep loss and sleep disorders represent an under-recognized public health problem and have been associated with a wide range of health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke. Almost 20 percent of all serious car crash injuries in the general population are associated with driver sleepiness. Hundreds of billions of dollars a year are spent on direct medical costs related to sleep disorders such as doctor visits, hospital services, prescriptions, and over-the-counter medications.” An Unmet Public Health Problem

15. Copyright © 2001 by Harcourt, Inc. All rights reserved. Effects on health Dr. Jan Born-- Univ. of Luebeck, Germany found that people who sleep only 6 hours: Have lowered their resistance to viral infection by 50% Produce half the flu fighting antibodies after a flu shot

16. Copyright © 2001 by Harcourt, Inc. All rights reserved. Up to 70 million working Americans suffer from sleep deprivation. The cost to businesses is enormous a worker with insomnia costs their employer over $3,225 more each year in health care costs Sleep-deprived workers are responsible for causing a 250% increase in serious work errors, many work related accidents, and increases in absenteeism and presenteeism (5.6 hours per week in lost productive time compared to 3.3 hours lost in non-fatigued workers). American Institute for Preventive Medicine Effects on workers

17. Copyright © 2001 by Harcourt, Inc. All rights reserved. –Three Florida A&M University students were involved in a fatal car accident off Interstate 10. The 5:30 a.m. accident on Jan. 6 left two of the students injured and one dead. Freshmen Antoine Gordon, 18.; Carlos Wilkins, 18; and Cornell Wedge, 19, were driving back to campus from winter break when Wilkins fell asleep at the wheel. Wilkins said once Wedge, who sat in the passenger seat, noticed Wilkins was asleep he tried to wake him. However, with the semi truck that rode beside them as well as the constant nudge from Wedge, Wilkins was startled and lost control of the Ford Escort. The car veered off the road into a ravine and hit three trees. Gordon, who was asleep in the backseat with no seatbelt, died on impact. Prior to the accident, Gordon's mother said she sensed the group was tired and insisted they pull over and rest before continuing to campus. Instead of taking a break, the three students decided to continue driving. Effects on driving (Jan, 2008)

18. Copyright © 2001 by Harcourt, Inc. All rights reserved. –Physiological effects (underaroused cortex) –Poor judgment –Driving 60 mph… how far do you travel during a microsleep (4 sec)? Conservative estimate: 100,000 accidents/yr; 1500+ deaths/yr Majority occur between 12 & 6 a.m. “Drowsy Driving”

19. Copyright © 2001 by Harcourt, Inc. All rights reserved. *Approximate breath ethanol concentration (BrEC) at peak; † Above 0.05% for legal intoxication in many states. N=32 healthy subjects without prior sleep deprivation and with  85% sleep efficiency. Sleep loss group (n=12) was tested in all 4 conditions, with 3 to 7 days of recovery time between tests, and compared with ethanol group (n=20). Roehrs T, et al. Sleep. 2003;26:981-985. BrEC, %* Sleep time (hours in bed) Legal Intoxication † Hours of Sleep and Equivalent Blood Alcohol Level for Sedative Effects

20. Copyright © 2001 by Harcourt, Inc. All rights reserved. Relationship between sleepiness & accidents Approximately 27% of drivers who have lost consciousness behind the wheel fell asleep as opposed to fainting, seizure, heart attack, etc. Importantly, this 27% accounted for 83% of the fatalities. Parsons, 1986 QJM.

21. Copyright © 2001 by Harcourt, Inc. All rights reserved. NSF campaign against Drowsy Driving

22. Copyright © 2001 by Harcourt, Inc. All rights reserved. The relationship between substance abuse and sleep disturbance is bidirectional. Not only does substance abuse lead to sleep disturbances, but sleep disturbance can lead to substance abuse. One way that sleep disturbance may create a pathway for substance abuse is that the combinations of sleep disturbance, excessive daytime sleepiness, and poor outcomes, can lead to self-medication. Students may use stimulants to increase daytime alertness and alcohol and marijuana to decrease depressive mood and sleep problems. Substance use and sleep deprivation Bootzin & Stevens, 2005

23. Copyright © 2001 by Harcourt, Inc. All rights reserved. Considerable scientific evidence supports a role of sleep in memory and learning. Numerous investigators have reported sleep-dependent learning across sensory, skill, and motor memory domains. Both animal and human studies especially implicate sleep as important for the process of memory consolidation following initial learning. Distinct memory processes may be related to specific sleep states (i.e., REM) such that sleep disruption negatively impacts learning. Effects on learning

24. Copyright © 2001 by Harcourt, Inc. All rights reserved. Effects on cognitive performance Reduced ability to process, concentrate & remember Reduced ability to communicate 1/3/08 Fatigue Factor Gives Equal Time to Candidates (NYTimes) –Mike Huckabee offered his “apologies” last week over the killing of former Prime Minister Benazir Bhutto of Pakistan. (He meant “sympathies,” his campaign clarified.) Sleeping much? “Obviously, I could use more than I am getting,” said Mr. Huckabee, who is down to about four hours a night. –“We had 300 people outside, literally freezing to death,” Senator Hillary Clinton marveled on Tuesday before a crowd in Iowa City. (No deaths were reported, in fact.) –Senator Barack Obama blamed fatigue for his drastically overstating the death toll from tornadoes in Kansas in May. He said 10,000 people died. (12 did.)

25. Copyright © 2001 by Harcourt, Inc. All rights reserved. Effects on cognitive performance Poor decision skills and increased risk- taking Reduced ability for complex problem- solving (study on REM- vs. NREM-deprived students) Reduced vigilance and increased errors (study on Marines in training)

26. Copyright © 2001 by Harcourt, Inc. All rights reserved. –Proposed college structural changes: No 8 a.m. classes (delayed sleep phase) No 1 p.m. or 2:30 p.m. classes (circadian dip) No more exams or papers or anything else that might make you need to stay up late (stress) Just one class for everyone at 9:30 a.m., or better… 10:30 ish… –WAKE UP! says Diet Pepsi Max What to do??

27. Copyright © 2001 by Harcourt, Inc. All rights reserved. What to do?? Take a pill for “perfect” sleep or find the “perfect” mattress

28. Copyright © 2001 by Harcourt, Inc. All rights reserved. –When we don’t get enough sleep, our bodies DEMAND it. Listen to that demand… –Get out of debt… “sleep debt” –Sleep hygiene Fitness, nutrition, nicotine, caffeine, alcohol, “worry time,” establish routine cycles (don’t change drastically on weekends) What about naps? What to do, really…