Sleep & Well-being Neuroscience of Sleep & Clocks Impact of - PowerPoint PPT Presentation

Sleep & Well-being • Neuroscience of Sleep & Clocks • Impact of Sleep Disruption • Sleep in the Young • Sleep “Hygiene” • Mental Illness • Discussion

http://www.eye.ox.ac.uk/research/sleep- circadian-neuroscience-institute

24h body clocks (circadian clocks) and sleep processes have captured the popular imagination……

Sometimes… not always helpful!

Sleep & Well-being • Neuroscience of Sleep & Clocks • Impact of Sleep Disruption • Sleep in the Young • Sleep “Hygiene” • Mental Illness • Discussion

Mood Growth Hormone ng/ml Melatonin pmol/l 10pm 7am 28 200 5 14 100 0 0 0 5 14 02 14 02 14 14 02 14 14 Core Body Temperature °C Systolic Pressure mm Hg Cortisol µg/100ml 200 150 37.5°C 100 100 36.75°C 0 50 36°C 02 14 14 14 02 14 14 02 14 Sleep Alertness Urine volume ml/Min. 3.0 100 100 1.5 50 75 0 0 50 02 14 14 02 14 14 02 14 14 10

Stroke Frequency 06.00 12.00 06.00 12.00 Oxford Vascular Study (Peter M Rothwell )

Alcohol Intake Alertness Cognitive Performance Clock Time Cognitive Performance 06:00 Time of day Rajaratnam SMW, Arendt J. Health in a 24-h society. Lancet 2001; 358: 999-1005.

Lifetime Activities General activities Sleep 19% 36% Work & Work related 16% Telephone/ Mail/Email 1% Watching TV Sport/Exercise Eating & 11% 1% Socialising Drinking 3% 11% Household work 8% Data from - American Time Use Survey Summary 2011 http://www.bls.gov/tus/

~21.5 years asleep!

"Enjoy the honey-heavy dew of slumber". Julius Cesar “O sleep, O gentle sleep, nature's soft nurse, how have I frighted thee…..” Macbeth “Sleep is the golden chain that ties health and our bodies together.” Thomas Dekker (1572 – 1632)

“Sleep is a Thomas Edison criminal waste of time and a heritage from our cave days”

Light Sleep Slow Wave Sleep Rapid Eye Movement Sleep SLEEP (NREM and REM) WAKE (States and Activity) Wake

Glutamate Acetylcholine Serotonin GABA Noradrenaline Galanin Histamine Orexin Dopamine SLEEP (NREM and REM) WAKE (States and Activity)

Cortex Thalamus Mid-Brain Hind-Brain Cortex Hypothalamus Pons Sleep is a global brain event!

SLEEP (NREM and REM) WAKE (States and Activity) Clock Sleep Pressure Social Timing

The Generation of 24h Rhythms Suprachiasmatic nuclei (SCN) The “master” body clock

Suprachiasmatic nuclei (SCN)

Emotional/Mental Cognitive Health Health Overall Health Pineal Melatonin SLEEP (NREM and REM) WAKE (States and Activity) Eye Clock Sleep Pressure Social Timing

Sleep & Well-being • Neuroscience of Sleep & Clocks • Impact of Sleep Disruption • Sleep in the Young • Sleep “Hygiene” • Mental Illness • Discussion

Sleep Disruption • Loss of Attention • High level of Micro-Sleeps • Failure to process information • Memory Impairment • Reduced Cognition and Creativity • Immune Suppression • Increased Cancer Risk • Increased Cardiovascular Disease • Risk of Diabetes II and Metabolic Syndrome • Mood Instability • Anxiety • Increased Stimulant/Sedative Use • Impulsivity • Increased Risk of Acute/Mental Illness

In USA 100,000 crashes every year are related to sleepiness . 1989 Accident investigators determined that fatigue was a factor in the crash, and the Exxon Shipping Company was criticised for failing to provide a rested crew 1986 2010 The International Nuclear Safety Group determined that human error related to sleep deprivation was a factor in the accident. Air India Express Accident investigators said that the pilot could be heard snoring on the cockpit voice recorder shortly before the disastrous landing.

Effect of sleep deprivation on brain activation while performing mathematical tasks (fMRI) Rested

Effect of sleep deprivation on brain activation while performing mathematical tasks (fMRI) Rested Sleep Deprived

Appetite - + Leptin Ghrelin Adipose Tissue Sleep Disruption

Sleep Disruption + + STRESS Glucose Immunity Blood Insulin Pressure Gastric Impaired Pituitary Gland Acid Memory Adrenal Gland Mood Anxiety & Instability CORTISOL Depression

Sleep & Well-being • Neuroscience of Sleep & Clocks • Impact of Sleep Disruption • Sleep in the Young • Sleep “Hygiene” • Mental Illness • Discussion

“Ideal” Good Sleeper Tue WAKE SLEEP Mon WAKE SLEEP Sun WAKE SLEEP Sat WAKE SLEEP Fri WAKE SLEEP Thur WAKE SLEEP Wed WAKE SLEEP Tue WAKE SLEEP Mon WAKE SLEEP DAY NIGHT 7am 11pm 7am Stable Sleep

“Elderly” Sleep/Wake Pattern Tue WAKE SLEEP Mon WAKE SLEEP Sun WAKE SLEEP Sat WAKE SLEEP Fri WAKE SLEEP Thur WAKE SLEEP Wed WAKE SLEEP Tue WAKE SLEEP Mon WAKE SLEEP DAY NIGHT 7am 11pm 7am Reduced and Fragmented Sleep

“Teenager” Sleep/Wake Tue WAKE SLEEP Mon WAKE SLEEP Sun WAKE SLEEP Sat WAKE SLEEP Fri WAKE SLEEP Thur WAKE SLEEP Wed WAKE SLEEP Tue WAKE SLEEP Mon WAKE SLEEP DAY NIGHT 7am 11pm 7am Greatly Delayed and Reduced Sleep

Delayed Body Clock (Biology)

Morning vs Evening Preference Evening changes with age 5.5 Chronotype (MSF sc , time around midnight) 5.0 4.5 4.0 3.5 Male 3.0 10 20 30 40 50 60 70 80 Age Morning Roenneberg et al. , Curr Biol, 2004

Morning vs Evening Preference Evening changes with age Making a teenager 5.5 get up at 07.00 is Chronotype (MSF sc , time around midnight) the same as making a 50 year 5.0 old getting up at 05.00! 2 hour difference 4.5 4.0 3.5 Male Female 3.0 10 20 30 40 50 60 70 80 Age Morning Roenneberg et al. , Curr Biol, 2004

Reduced Sleep (Sociology)

Mary Carskadon at Brown University suggests that, on average, US teenagers are getting about 7.5 hours a night's sleep on school nights, but as many as 25% get fewer than 6.5 hours per night. Mary estimates that to be optimally alert, teenagers need approximately 9 hours of sleep.

Impact of a later school start time

Pilot Study - Monkseaton School (Newcastle, UK). Headmaster: Paul Kelly Students 15-16 taking GCSEs % Students Reaching Government Standard National Average 60 5+ GCSE Passes Grade C or Higher 52% 50 53% 44% 40 35% 42% 30 20 All Students 10 12% Socially Disadvantaged 0 08.50 10.00 10.00 (2010) (2011) (2012) Kelley, P., Lockley, S.W., Foster, R.G. n = and Kelley, J., (2014) Synchronizing 169 166 164 education to adolescent biology: ‘Let teens sleep, start school later’, n = 29 30 49 Learning, Media and Technology, Neuroscience and Education Special School Start Time Issue, (in press)

Sleep & Well-being • Neuroscience of Sleep & Clocks • Impact of Sleep Disruption • Sleep in the Young • Sleep “Hygiene” • Mental Illness • Discussion

Opinion 22 April 2013 “Why teenagers really do need an extra hour in bed”

Opinion 22 April 2013 Not getting enough sleep if…. • You are dependent upon an alarm clock, or parent, to get you out of bed. • You “over-sleep” extensively on free-days. • You take a long time to wake up. • You feel sleepy and irritable during the day. • Your behaviour is overly impulsive. • Crave caffeinated and sugar-rich drinks. • If your friends and family notice changes in your normal behaviour – irritable, loss of empathy; disinhibited…..

Opinion 22 April 2013 So…. Take control. “Why teenagers really do need an extra hour • Bedroom must be dark and not too warm. in bed” • “Calm down” prior to sleep. • Prepare for sleep ~ 9h before the morning alarm. • Don't text, watch TV, use computer etc. 30min before bed. • Avoid bright lights 30min before bed. • Try not to nap during the day. • Avoid caffeinated drinks after lunch. • Seek out natural light in the morning to adjust the body clock and sleep patterns to an earlier time.

Environmental Lighting Typical Range Lux Situation 100,000 Bright sunny day 10,000 Cloudy day > 4000 lux 1000 - 2000 Watch repairman's bench 100 - 600 Typical office setting 1 - 10 Residential street lighting 0.25 Cloudy moonlight < 100 lux

Sleep & Well-being • Neuroscience of Sleep & Clocks • Impact of Sleep Disruption • Sleep in the Young • Sleep “Hygiene” • Mental Illness • Discussion

Emotional/Mental Cognitive Health Health Overall Health SLEEP WAKE Eye Clock Sleep Pressure Social Timing

Emil Kraepelin (1856 -1926) Noted in his 1883 textbook that abnormal sleep patterns and mental health are linked.

Since the 1970’s…….. Sleep/Clock disruption in schizophrenia has been viewed merely as the by-product of antipsychotic medication

And……….Abnormal sleep in schizophrenia is often dismissed on the basis of lack of work. Typical comment: “my patients can’t hold down a job - so no wonder they get up late, miss my clinic and don’t have friends”. (annon)

How bad is sleep and circadian rhythm disruption in schizophrenia……?