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Sleep Matters the Impact of Sleep on Health and Wellbeing Mental Health Awareness Week 2011
Sleep Matters The impact of sleep on health and wellbeing Mental Health Awareness Week 2011 Address Mental Health Foundation Sea Containers House 20 Upper Ground London SE1 9QB United Kingdom Telephone 020 7803 1100 Email [email protected] Website www.HowDidYouSleep.org £10 IBSN 978-1-906162-65-8 Registered charity number England 801130 Scotland SC039714 © Mental Health Foundation 2011 Contents 04 Executive summary 08 Introduction 12 Part 01 – Sleeping and sleep patterns 28 Part 02 – Poor sleep 48 Part 03 – Sleeping well 62 Conclusion 66 Useful resources 68 References 72 Appendix: Sleep diary 76 Acknowledgements 01 ‘The main facts in human life are five: E. M. Forster Executive We spend approximately a Poor sleep over a sustained period One of the most widely used and – The new Public Health Outcomes third of our lives asleep. Sleep leads to a number of problems which successful therapies is Cognitive Framework should include a specific Summary are immediately recognisable, including Behavioural Therapy (CBT). This is outcome on reducing sleep problems is an essential and involuntary fatigue, sleepiness, poor concentration, useful even for people who have across the whole population. process, without which we lapses in memory, and irritability. had insomnia for a long period of time. Sleep should also be reflected in cannot function effectively. A full course of such a therapy with new national mental health outcome It is as important to our Up to one third of the population may a sleep specialist is potentially costly, indicators, including improving bodies as eating, drinking suffer from insomnia (lack of sleep and is most appropriate for people sleep for people who experience and breathing, and is vital for or poor quality sleep). -
The Importance of Healthy Sleep
THE IMPORTANCE OF HEALTHY SLEEP Disorders like Sleep Apnea, Periodic Limb Movement Disorder, Narcolepsy and Insomnia negatively impact your health. It is estimated that Sleep Apnea affects approximately 40 million people, with 90% going undiagnosed. TABLE OF CONTENTS Are you at risk?- Sleep Disorders Questionnaire • Epworth Sleepiness Scale • STOP BANG- Sleep Apnea Screening Questionnaire Sleep Disorders • Sleep Apnea • Narcolepsy • Restless Leg Syndrome/Periodic Limb Movement Disorder • Insomnia • Snoring Testing • Polysomnography • Portable Home Sleep Study • Split night • CPAP titration • MSLT- Multiple Sleep Latency Study • High Resolution Pulse Oximetry Screening Types of Treatment • CPAP • Oral Appliances • Surgical Interventions Sleep Health/Good Sleep Hygiene Sleep Lab at Wayne HealthCare Resources and References 3 DID YOU KNOW? According to the National Heart, Lung, and Blood Institute: • Approximately 42 million American adults suffer from sleep-disordered breathing (SDB) • 1 in 5 adults has mild OSA (Obstructive Sleep Apnea) • 1 in 15 has moderate to severe OSA (75% to 90% of severe SDB cases remain undiagnosed) • 9% of middle-aged women suffer from OSA • 25% of middle-aged men suffer from OSA For more information visit www.nhlbi.nih.gov. Sleep apnea that goes untreated can worsen conditions such as: • Coronary Artery Disease • Hypertension • Atrial Fibrillation • Type-2 Diabetes • Congestive Heart Failure • Obesity • Stroke • Glacoma 4 ARE YOU AT RISK? The Epworth Sleepiness Scale How likely are you to doze off or fall asleep in the following situations in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. -
2021 Magellan Clinical Guidelines for Medical Necessity Review
National Imaging Associates, Inc.* 2021 Magellan Clinical Guidelines For Medical Necessity Review SLEEP STUDY GUIDELINES Effective January 1, 2021 – December 31, 2021 *National Imaging Associates, Inc. (NIA) is a subsidiary of Magellan Healthcare, Inc. Copyright © 2019-2021 National Imaging Associates, Inc., All Rights Reserved Guidelines for Clinical Review Determination Preamble Magellan is committed to the philosophy of supporting safe and effective treatment for patients. The medical necessity criteria that follow are guidelines for the provision of diagnostic imaging. These criteria are designed to guide both providers and reviewers to the most appropriate diagnostic tests based on a patient’s unique circumstances. In all cases, clinical judgment consistent with the standards of good medical practice will be used when applying the guidelines. Determinations are made based on both the guideline and clinical information provided at the time of the request. It is expected that medical necessity decisions may change as new evidence-based information is provided or based on unique aspects of the patient’s condition. The treating clinician has final authority and responsibility for treatment decisions regarding the care of the patient. 2021 Magellan Clinical Guidelines-SLEEP STUDY 2 Guideline Development Process These medical necessity criteria were developed by Magellan Healthcare for the purpose of making clinical review determinations for requests for therapies and diagnostic procedures. The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, cardiology, and other specialty groups. Magellan’s guidelines are reviewed yearly and modified when necessary following a literature search of pertinent and established clinical guidelines and accepted diagnostic imaging practices. -
Slow-Wave Sleep, Diabetes, and the Sympathetic Nervous System
COMMENTARY Slow-wave sleep, diabetes, and the sympathetic nervous system Derk-Jan Dijk* Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XP, United Kingdom leep oscillates between two dif- of SWS that has accumulated. The latter less provides supportive evidence for the ferent states: non-rapid eye conclusion was derived from SWS depri- notion that SWS is restorative also for movement (NREM) sleep and vation experiments in which stimuli, usu- the body and that negative effects asso- rapid-eye movement (REM) ally acoustic stimuli [although early on ciated with disruption of this state may Ssleep. Slow-wave sleep (SWS) is a sub- in the history of SWS deprivation, mild extend to the body. state of NREM sleep, and its identifica- electric shocks were used (5)], are deliv- Many other physiological variables are tion is based primarily on the presence ered in response to the ongoing EEG. affected by the behavioral-state sleep, of slow waves, i.e., low-frequency, high- The drive to enter SWS is strong and is the NREM–REM cycle, and SWS. amplitude oscillations in the EEG. Upon the transition from wakefulness to Quantification of SWS is accomplished sleep, heart rate slows down. During by visual inspection of EEG records or Short habitual sleep sleep, the balance of sympathetic and computerized methods such as spectral parasympathetic tone oscillates in syn- analysis based on the fast Fourier trans- has been associated chrony with the NREM–REM cycle. form (FFT). Slow-wave activity (SWA; Analysis of autonomic control of the also referred to as delta power) is a with increased risk variability of heart rate demonstrates quantitative measure of the contribution that, within each NREM episode, as of both the amplitude and prevalence of for diabetes. -
Sleep 101: the Abcs of Getting Your Zzzs
Sleep 101: The ABCs of Getting Your ZZZs Steven D. Brass, MD MPH MBA Director of Neurology Sleep Medicine Clinic UC Davis Health System November 18, 2014 What you will learn: • Why do we sleep? • How much sleep do we need? • What are the effects of sleep deprivation? • What are the different stages of sleep? • What are the types of sleep problems? • What is sleep apnea and how is it treated? • How can we sleep better? Why do we sleep? • Each of us will spend about 1/3 of our lifetime sleeping! • Sleep helps us with: – Memory consolidation – Immune system – Recharge energy for the day – Growth and development How much sleep do we need? Infants : 14-15 hours National Sleep Foundation Secrets of Sleep; National Geographic Magazine . 2010 Adolescents: 8.5-9.25 hours National Sleep Foundation Secrets of Sleep; National Geographic Magazine . 2010 Adult/Elder Sleep: 7-9 hours National Sleep Foundation Secrets of Sleep; National Geographic Magazine . 2010 What are the different stages of sleep? • Non REM Sleep -75% of the night – Stage 1 – Stage 2 – Stage 3 – Stage 4 • REM Sleep -25% of the night – Dreaming Normal Sleep Patterns in Young Adults REM Stage AWAKE NREM REM 1 2 3 4 1 2 3 4 5 6 7 8 Hours of Sleep Adapted from Berger RJ. The sleep and dream cycle. In: Kales A, ed. Sleep Physiology & Pathology: A Symposium. Philadelphia: J.B. Lippincott; 1969. American Academy of Sleep Medicine Sleep Fragmentation Affects Sleep Quality NORMAL SLEEP = Paged ON CALL SLEEP © American Academy of Sleep Medicine, Westchester, IL Why do we dream? • Everyone -
Sleep Disorders Preeti Devnani
SPECIAL ISSUE 1: INVITED ARTICLE Sleep Disorders Preeti Devnani ABSTRACT Sleep disorders are an increasingly important and relevant burden faced by society, impacting at the individual, community and global level. Varied presentations and lack of awareness can make accurate and timely diagnosis a challenge. Early recognition and appropriate intervention are a priority. The key characteristics, clinical presentations and management strategies of common sleep disorders such as circadian rhythm disorders, restless legs syndrome, REM behavior disorder, hypersomnia and insomnia are outlined in this review. Keywords: Hypersomnia, Insomnia, REM behavior International Journal of Head and Neck Surgery (2019): 10.5005/jp-journals-10001-1362 INTRODUCTION Department of Neurology and Sleep Disorder, Cleveland Clinic, Abu Sleep disorders are becoming increasingly common in this modern Dhabi, United Arab Emirates era, resulting from several lifestyle changes. These complaints may Corresponding Author: Preeti Devnani, Department of Neurology present excessive daytime sleepiness, lack of sleep or impaired and Sleep Disorder, Cleveland Clinic, Abu Dhabi, United Arab Emirates, quality, sleep related breathing disorders, circadian rhythm disorder e-mail: [email protected] misalignment and abnormal sleep-related movement disorders.1 How to cite this article: Devnani P. Sleep Disorders. Int J Head Neck They are associated with impaired daytime functioning, Surg 2019;10(1):4–8. increased risk of cardiovascular and cerebrovascular disease, poor Source of support: Nil glycemic control, risk of cognitive decline and impaired immunity Conflict of interest: None impacting overall morbidity and mortality. Diagnosis of sleep disorders is clinical in many scenarios, The following circadian rhythm sleep–wake disorders adapted polysomnography is a gold standard for further evaluation of from the ICSD-3: intrinsic sleep disorder such as obstructive sleep apnea (OSA) • Delayed sleep–wake phase disorder and periodic limb movement disorder (PLMD). -
Ac 120-100 06/07/10
U.S. Department Advisory of Transportation Federal Aviation Administration Circular Date: 06/07/10 AC No: 120-100 Subject: Basics of Aviation Fatigue Initiated by: AFS-200 Change: 1. PURPOSE. This advisory circular (AC): • Summarizes the content of the FAA international symposium on fatigue, “Aviation Fatigue Management Symposium: Partnerships for Solutions”, June 17-19, 2008; • Describes fundamental concepts of human cognitive fatigue and how it relates to safe performance of duties by employees in the aviation industry; • Provides information on conditions that contribute to cognitive fatigue; and • Provides information on how individuals and aviation service providers can reduce fatigue and/or mitigate the effects of fatigue. 2. APPLICABILITY. This AC is not mandatory and does not constitute a regulation. 3. DEFINITIONS. a. Circadian Challenge. Circadian challenge refers to the difficulty of operating in opposition to an individual’s normal circadian rhythms or internal biological clock. This occurs when the internal biological clock and the sleep/wake cycle do not match the local time. For example, the sleep period is occurring at an adverse circadian phase when the body wants to be awake. Engaging in activities that are opposite of this natural biological system represents the circadian challenge (e.g., night work, shift work, jet lag). b. Cognitive Performance. Cognitive performance refers to the ability to process thought and engage in conscious intellectual activity, e.g., reaction times, problem solving, vigilant attention, memory, cognitive throughput. Various studies have demonstrated the negative effects of sleep loss on cognitive performance. c. Circadian Rhythm. A circadian rhythm is a daily alteration in a person’s behavior and physiology controlled by an internal biological clock located in the brain. -
NIGHT TERRORS Cause Expected Course PREVENTION of NIGHT
NIGHT TERRORS your DEFINITION wall, or break a window. Try to gently direct child back to bed. 1 btlt cannot be o Your child is agitatecl ancl restless 3. Prepare babysitters or overnight leaders for awakened or comforted. the-e episodes' Explain to people who care for o Your child may sit up or run helplessly about, possi- your chilcl what a night terror is and what to do if bl1' screaming or talking wildll'. one happens. Understanding this will prevent them he r Although your child appears to be anxious, from overreacting if your child has a night terror' doesn't mention any specilic fears. o \bur child doesn't appear to realize that you are there. Although the eyes are wide open and staring, PREVENTIONOF NIGHTTERRORS you. 1'our child looks right through 1. Keep your child from becoming overtired' or persons in the . Your child may mistake obfects Sleep deprivation is the most common trigger for room for dangers. night terrors. For preschoolers, restore the after- after going to sleep' . The episode begins I to 2 hours noon nap. If your child refuses the nap, encourage r to minutes' The episode lasts from 10 30 a l-hour "quiet tim€." Also avoid late bedtimes be- . the episode in the Your chil<J cannot remembcr cause they may trigger a night terror. If your child morning (amnesia). needs to be awakened in the morning, that means yearsold. r The child is usually I to 8 he needs an earlier bedtime. Move lightsout time by a physician' o This cliagnosismust be confirmed to 15 minutes earlier each night until your child can self-awakenin the morning. -
Sleep Deprivation in Horses Sleep Is a Vital Aspect of Overall Health; But, Unfortunately, Equine Sleep Disorders Are Poorly Understood
EQUINE | BEHAVIOUR AND WELLBEING ONLINE EDITION Sleep deprivation in horses Sleep is a vital aspect of overall health; but, unfortunately, equine sleep disorders are poorly understood. There are few peer-reviewed publications on the subject and many veterinary professionals and owners are left to manage situations based upon their personal experience, rather than evidence-based medicine. Sleep deprivation is a (SWS), the head will hang prey animal, this is not in their noticeable ailment which lower, and if the horse is survival nature. Horses need Joanna de Klerk suggests there are underlying content in its environment, it BVetMed (Hons) MScTAH MRCVS a minimum of approximately factors in the horse’s health will lie down in either sternal three to five hours sleep per Jo is a graduate of the Royal or environment that need to or lateral recumbency. 24-hour period. This time Veterinary College, London. be addressed. Equine sleep must include both SWS and She has a Masters Degree in patterns are adaptable – This is not essential REM sleep. Tropical Animal Health, and because, in the wild, horses though, because through has spent most of her career may have periods of time when the mechanism of the ‘stay Foals, on the other hand, working in mixed veterinary they must be more alert for apparatus’, a horse can require much more sleep than practice. Recently, she has predators. Therefore, a horse sleep in the SWS phase of an adult horse. Foals spend become involved in one of the can go for up to three days the cycle with relatively little 15 to 33 per cent of their time UK’s fasted growing veterinary with inadequate sleep before effort. -
Evaluating and Managing Sleep Disorders
Evaluating & Managing Sleep Disorders Julia Aziz, M.D. Daniel Lewin, Ph.D., D.ABSM Division of Pediatric Pulmonology and Sleep Medicine Children’s National Health System Washington, D.C. Future of Pediatrics, 2019 Topics • Basics about sleep • Effects of insufficient sleep • Common sleep problems and disorders: signs symptoms and treatment Awake Drowsy Stage 1 Stage 2 Stage 3 Stage REM Hypnogram Sleep Stage Distribution Wake REM Stage 1 Stage 2 Stage 3 Time 2200 2400 200 400 600 800 NonREM Stage 3 is dominant during the first half of night Sleep stage REM is dominant during the second half of night Process S Sleep Homeostatic Process C Circadian Sleep Academic Award, Gerald Rosen Process S Sleep drive Homeostatic Reduced Sleep drive 1st sleep 2nd sleep Process C Circadian Sleep Academic Award, Gerald Rosen Sleep Time and Timing Sleep and Circadian Health Effects • Metabolism regulation and energy expenditure • Physical restoration • Tissue repair • Neuronal recalibration • Memory consolidation The Sleep Habits Assessment Bedtime EDS Awakenings Regularity Snoring (Excessive Daytime Somnolence) .Routine .Hyperactivity .Call outs .Schedule .Volume .Resistance .Irritability .Partial Arousal .Age .Pauses .Fears .Difficulty waking .Restlessness .Periodicity Adapted from: Mindel, JA, & Owens. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Lippincott, Williams & Wilkins. Philadelpha (2003) Outline I. Evaluating & Managing obstructive sleep apnea (OSA) – Clinical assessment of OSA – Who, when, where and how to -
Excessive Daytime Sleepiness Revealing Idiopathic Hypersomnia in a Young Air Traffic Controller
Central Journal of Sleep Medicine & Disorders Case Report *Corresponding author MONIN Jonathan, Aeromedical Center, Percy Military Hospital, 101 avenue henri Barbusse 92140 CLAMART, Excessive Daytime Sleepiness France, Tel: 331-4146-7022, Email: jonathan.monin@ hotmail.fr Revealing Idiopathic Hypersomnia Submitted: 10 September 2020 Accepted: 19 September 2020 Published: 21 September 2020 in a Young Air Traffic Controller ISSN: 2379-0822 MONIN Jonathan1,2*, GUIU Gaëtan1,3, BISCONTE Sébastien1, Copyright © 2020 Jonathan M, et al. PERRIER Eric1,3, and MANEN Olivier1,3 1Aeromedical Center, Percy Military Hospital, Clamart, France OPEN ACCESS 2Department of Sleep Medicine, Percy Military Hospital, Clamart, France 3French Military Health Service Academy, Paris, France Keywords • Idiopathic Hypersomnia • Excessive daytime sleepiness • Air traffic controller Abstract The authors report the case of a young air controller suffering from asthenia and excessive daytime sleepiness, in who rare sleep pathology is highlighted: idiopathic hypersomnia. This case raises the problem of the compatibility of sleep disorders with flight safety. ABBREVIATIONS REM: Rapid Eye Movements; MSLT: Multiple Sleep Latency of reduced physical or intellectual activity remains fragile and Test drowsiness may set in during the day. INTRODUCTION During repeated periods of sleep deprivation linked to her job as an air traffic controller, in addition to significant asthenia, Sleepiness is one of the major concerns in aviation medicine attention and mood disorders, and hyper-responsiveness to stress appear. Until then, she had been highly motivated by the because of the potential risk to flight safety. This case highlights military aviation environment, first as a civilian glider and private the management of an air traffic controller from the discovery of pilot with 250 hours of flight time, then as an air mechanic, before drowsiness to diagnosis, while studying the consequences on his turning to air traffic control. -
Sleep Review of Systems ISNORED.Qxd
SLEEP REVIEW OF SYSTEMS “ISNORED” Incorporate a Sleep Review of Systems into your General Review O—OLDER (see SNORING above) or OBESE. of Systems. It' s easy to remember the phrase: "I SNORED." (Modified from I SNORED by Edward F. Haponik, M.D., Wake R—RESTORATIVE or REFRESHING SLEEP. Normal per- Forest University School of Medicine) sons who have adequate sleep time in awakening feeling refreshed with a high energy level. Sleep has many functions including I - Insomnia memory consolidation, tissue repair, and many other physiologi- S - Snoring and Sleep Quality cal consequences. Many of the more than 88 sleep disorders may N - Not Breathing result in non-restorative sleep because of multiple nocturnal O - Older or Obese awakenings or disruption of the normal sleep architecture. R - Restorative or Refreshing Sleep E - Excessive Daytime Sleepiness E—EXCESSIVE DAYTIME SLEEPINESS. Excessive day- D - Drugs or Alcohol time sleepiness is when people have the strong urge to sleep dur- ing inappropriate times or even drift into sleep. Patients report "I SNORED" will help you to remember to ask about sleep dis- falling asleep doing inactive tasks such as reading or watching tel- orders in your practice. Sleep disorders afflict millions of evision. There are subjective measures of daytime sleepiness Americans and remain undiagnosed in a significant number of including the Epworth Sleepiness Scale, Stanford Sleepiness individuals, partially because their physicians don't inquire about Scale, and a Linear Analog Scale. It's important to ask whether sleep problems or excessive daytime sleepiness. the patient falls asleep while driving since this may lead to mor- bidity and mortality and patients should be instructed to refrain I—INSOMNIA is very common, and a recent Gallup Poll from driving their sleep disorder is diagnosed and adequately showed that 9% of respondents had chronic insomnia and 27% treated.