2. Why Study Sleep?
• We spend 1/3 of our lives sleeping
• 1 in 7 Canadians are not getting enough sleep (Statistics
Canada, 2002)
• Severe health consequences - DEATH!
• Sleep deprivation costs
$150 BILLION/yr in lost
productivity
(Nat’l Commission on Sleep Disorders, 2003)
5. Purpose of Sleep
• Restorative Function
• Energy Conservation
• Immune Function Regulation
• Memory Consolidation
• Mood Regulation and depression
• Protective Mechanism
9. What Happens at the Sleep Lab…
• ROMHC: 6 bed clinical lab, 4 bed research lab
STEPS:
1) → Referral
2) → Consultation with a Sleep Specialist
3) → Overnight Sleep Study
4) → Data is Analyzed by RPSGTs
5) → Results Appt with a Sleep Specialist
10. How Do We Measure Sleep in the
Laboratory?
• EEG – brainwaves (Central & Occipital Leads)
• EOG – eye movements
• EMG – muscle tone
• EKG/ECG – heart
• Breathing:
1)Airflow
& 2) Effort: Thoracic & Abdominal
• Blood oxygen saturation (SaO2)
• Snore mic.
• Digital AV recording
11.
12.
13.
14. STAGES OF SLEEP
• NREM & REM
• NREM = N1, N2, N3
• Sleep Cycle
• REM increases as the night progresses
• Changes across the lifespan
15. NREM SLEEP
• N1: lightest stage of sleep
(hypnic jerks/sleep starts), dozing
• N2: Sleep spindles & K complexes
• N3 (formerly stages 3 & 4): deepest most
physically restorative stage of sleep. More
difficult to awaken from this stage. Decreases
with age.
• Breathing regular, heart rate decreases
44. PARASOMNIAS
• NREM
Sleepwalking (Somnambulism)
Sleep Terrors (aka Night Terrors)
Others examples: Sleep Related Eating Disorders,
Confusional Arousals, Somniloquy
■ REM
REM Behaviour Disorder (RBD)
Measured in the sleep lab with full EEG to rule out seizure
activity
45. SLEEPWALKING
• Stage N3 (slow wave sleep)
• Common in children
• Do not awaken. Secure the environment
• No recall of a dream or of the episode
• Aggravated by sleep deprivation, stress, alcohol
• Positive family history
• Perform complex behaviours with heightened
pain threshold
47. REM Behaviour Disorder (RBD)
• No muscle atonia during REM sleep
• Ability to act out complex dream behaviour
• Bedpartner often the “victim”
• Age of onset: 50 – 60yrs. Males
• Usually opposite of waking personality
• Case study: “baseball player” at ROMHC
50. Treatments for RBD
• Full EEG montage during PSG
• CT Scan, MRI – r/o lesions
• Securing the environment (mattress on floor, bed
rails, restraints)
• Bedpartner sleeps in another room
• Rx
51. SLEEPWALKING vs. RBD
SleepwalkingSleepwalking
▪▪ Stage N3 (NREM)Stage N3 (NREM)
▪▪ No dream recallNo dream recall
▪▪ ChildrenChildren
▪▪ Not easily awakenedNot easily awakened
REM BehaviourREM Behaviour
DisorderDisorder
▪▪ REM sleepREM sleep
▪▪ Dream recallDream recall
▪▪ Adults (elderly)Adults (elderly)
▪▪ Easily awakenedEasily awakened
54. Restless Legs Syndrome (RLS)
• Disorder of WAKEFULNESS (PLMs = sleep)
• Subjective report of an uncomfortable sensation in
the legs while at rest
• Irresistible urge to move the legs
• Symptoms subside with movement
• “Creeping”, “itching”, “creepy-crawly”, “pulling”,
“tugging”, “gnawing”, “toothache in my legs”, “bugs
or worms crawling under my skin”
• Symptoms worse in the evening
• Almost all patients with RLS display PLMs during
sleep
55. RLS Treatments
• Pharmacological (dopamine agonists)
• Non-Pharmacological:
– Iron supplementation
– Warm bath
– Exercise
– Massage, acupuncture, relaxation techniques
– Keeping mind engaged when having to stay seated
– Eliminate caffeine and alcohol
– Bar of soap under the sheets!
58. SLEEP & MENTAL ILLNESS
• Depression
– Early morning awakenings
– Short REM latency
– Increased time in REM sleep
– May mimic narcolepsy on the MSLT
62. INSOMNIA
• Difficulty initiating and maintaining sleep
• Early morning awakenings
• Complaint of poor, insufficient or nonrefreshing
sleep
• Impact on waking behaviour
• Sleep Efficiency < 85%
• Longer SOL (> 30 minutes), short total sleep time
(TST)
64. GOOD SLEEP HABITS
• Get up at the same time each morning. Even if
you fall asleep very late, you should still get up at
the same time each morning
• To avoid “Sunday night insomnia, Monday
morning blues”, don’t stay up late on weekends
and then sleep in
• Go to bed only when sleepy
• Develop a relaxing pre-sleep ritual such as
reading, taking a bath, brushing your teeth, etc
65. GOOD SLEEP HABITS
• Use the bed only for sleep and intimacy
• Nicotine is a stimulant. Try not to smoke near
bedtime
• Hunger may disturb sleep. Perhaps try to have a
light snack before bed. A glass of warm milk
contains a natural sleep aid
• Exercise regularly. Get vigorous exercise either in
the morning or the afternoon and do only mild
exercise two to three hours before bed
66. GOOD SLEEP HABITS
• Don’t stay in bed if you can’t fall asleep within 15
minutes. Tossing and turning will just make you
more frustrated
• Get as much sleep as you need, but no more
• If you find yourself worrying at bedtime, set aside
a “worry time” – perhaps 30 minutes in the early
evening to write down both problems and
solutions