To Sleep or Not to Sleep

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To Sleep or Not to Sleep
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To Sleep or Not to Sleep

• Consequences of Sleep Loss

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Scenarios
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Scenarios
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2400
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Objectives

• Sleep Science history
• Sleep Mechanics 101
• Sleep Deprivation Consequences
• Shift-work risks evidence
• Strategies
• Future research

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Sleep Science History

• 1930 Berger- Father of EEG
• 1937 Loomis- first overnight EEG human sleep
  recordings
• 1968 Standardized manual
• 1974-Williams normative sleep data
• 2010-Accreditated Sleep Centers

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Sleep Basics

• 3 Mechanisms
• ANS
• PNS ?
• SNS ?
• Homeostatic Sleep Drive
• Circadian Sleep Rhythm

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Sleep Stages
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Sleep Stages
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Sleep Stages
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Sleep Waves
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Sleep Architecture
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Sleep Architecture
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Sleep Architecture
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Circadian Sleep Disorders
irca
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Sleep Quantification

• Objective
• MSLT
• MWT
• PVT
• Subjective
• Sleepiness scales
• Stanford (1973 7 point)
• Karolinska (1990 9 point)
• Epworth (1991 situation-specific dozing
  likelihoods)

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Effects of Sleep Deprivation
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Effects of Sleep Deprivation
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Effects of Sleep Deprivation
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Recovery Studies
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Recovery Studies
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Recovery Studies
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Recovery Studies
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Shift-work Syndrome

• Prevalence
• (U.S.-22 M SW 3 ?)
• Canada 11 rotating, 6 evening, 2 nights
• Prototype
• Insomnia / Sleepiness
• Fatigue / Headache / Anxiety
• Indigestion / Pyrosis
• Hypertension
• Weight gain
• Menstrual irregularity / Sub-fertility / SA
• Depression
• Drowsy driving

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Sleep Deprivation Impact

• Individual
• Family
• Community
• Society

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Shift-work Impact
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Shift-work Impact
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Shift work Cardiovascular Disease

• Modest () associations w shift work (40)
• Causal link research inconsistent
• Daylight Saving Time
• Janszky (2008) Acute MI ? risk Mondays
• Spring Incidence ratio 1.051
• Autumn Incidence ratio 0.985

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Shift work (LAN) Cancer

• Schernhammer (2001) Nurses Health Study Cohort
• 240,000 women over 30 years
• Control for major risk factors, stress, SE status
• Cancer relative risk ?
• Breast 36-79
• Colon 35
• Endometrial 43
• 2007 IARC classifies night shift work as
  probable carcinogen (2A)

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Shift work (LAN) Cancer

• Observational studies modest () relationship
  b/w LAN breast Ca
• Pukkala (1995) Flight attendants gt 15 Y
• Tynes (1996) Radio telegraph operators
• Prostate Ca ?
• Airline pilots
• Firefighters
• Health practitioners physicians

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Circadian Disruption Shift work Risk of Ca

• Seattle Research group
• LAN Breast Ca Case control study
• 60-Hz magnetic fields ? nocturnal melatonin
• Night shift work biomarkers
• Melatonin hormones
• Genotypes (hCLOCK, Per2, Per3)

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Shift work Pregnancy

• Moderate (-) effect on fetal growth
• SGA / LBW
• No association for pre-term delivery or
  pre-eclampsia

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Study Limitations

• Epidemiologic vs RCT
• Selection bias
• Survivor population (entrance drop-out)
• Lower socioeconomic status
• Shift work definition
• Exposure measurement

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Shift Work Proposed Mechanisms
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Shift-work Risk

• Needle-stick events
• Ayas (2006)
• Trinkoff (2007)
• Clinical performance
• Howard (2003)-Anesthesia
• Lockley (2004)-ICU
• Smith-Coggins (2006)-Emergency

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Transportation Safety

• Prototype drowsy driver
• Young male lt 25
• Shift-worker
• Untreated sleep disorder (OSA / Narcolepsy)
• Event 2400-0700
• Social Media Contagious

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Transport Sleep Deprivation

• Commercial
• Truck
• Rail
• Air / ATC
• Performance impairment Ethanol intoxication
• Dawson 1997
• Powell 2001
• Vakulin 2007

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Drowsy Driving Strategies

• Awareness
• Legislation
• Highway rumble strips
• Operator behavior
• Naps
• Caffeine
• Environmental stimuli

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Sleep Loss Countermeasures

• Pharmacologic
• Non-pharmacologic

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Sleep Loss Countermeasures

• Pharmacologic
• Antihistamines
• Benzodiazepines
• Non-benzodiazepines
• Antidepressants
• Serotonin modulator
• SSRIS
• SNRI
• Tetracyclic
• Tricyclic
• Melatonin receptor agonist
• Alternative
• Valerian
• Kava
• Chamomile
• Synthetic melatonin
• Non-pharmacologic

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Sleep Loss Countermeasures

• Pharmacologic
• Non-pharmacologic
• Behavioural
• Sleep deprivation
• Reconditioning
• Relaxation techniques
• CBT
• Schedule strategies
• Restrict maximum 3 consecutive shifts
• Forward shift rotation
• Participatory approach

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Sleep Hygiene
Wolkove, N. et al. CMAJ 20071761449-1454
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Sleep Hygiene
Wolkove, N. et al. CMAJ 20071761449-1454
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Sleep Hygiene
Wolkove, N. et al. CMAJ 20071761449-1454
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Sleep Hygiene
Wolkove, N. et al. CMAJ 20071761449-1454
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Sleep Hygiene
Wolkove, N. et al. CMAJ 20071761449-1454
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Future Research

• Common definitions (SW)
• Common assessment (exposures)
• Study intermediate pathways vs disease outcomes
• Outcome data NOT biomarkers

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Summary

• Sleep science 101
• Sleep debt awareness
• Sleep hygiene / art of sleeping
• Drowsy driving KILLS people

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Reference List
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A baby friendly way to establish
Any Questions?
Erica