Adolescent Sleep Daniel S. Lewin, Ph.D., D,ABSM Associate Director, - - PowerPoint PPT Presentation
Adolescent Sleep Daniel S. Lewin, Ph.D., D,ABSM Associate Director, Pediatric Sleep Medicine Childrens National Medical Center Associate Professor of Pediatrics George Washington University School of Medicine February 16, 2017 What is
Daniel S. Lewin, Ph.D., D,ABSM
Associate Director, Pediatric Sleep Medicine Children’s National Medical Center Associate Professor of Pediatrics George Washington University School of Medicine
February 16, 2017
“Sleep is a reversible
behavioral state of perceptual disengagement from and unresponsiveness to the environment. It is also true that sleep is a complex amalgam of physiological and behavioral processes ”. (Carskadon & Dement)
Awake Drowsy Stage 1 Stage 2 Stage REM Stage 3
Inhibition of centers
& Raphae Nuclei),
Neurons of CCx firing is slow & synchronized
Serotonergic pathways from the RAS to thalamus & hypothalamus initiate delta activity in the cerebral cortex
Inhibition of the Raphae and locus ceruleus Activation of the pontine nucleus through cholinergic and glutamic pathways Desynchronization
pathway broad activation of CCx Hyperpolarization of Motor neurons resulting in broad atonia
Wake REM Stage 1 Stage 2 Stage 3 Time
2200 2400 200 400 600 800
Hypnogram Sleep Stage Distribution
NonREM Stage 3 is dominant during the first half of night Sleep stage REM is dominant during the second half of night
Age group National Institutes of Health Population Study Switzerland {Iglowstein, 2003 Infants (Birth -12 months) 16-18 hours 13.9-14.2 hours Toddlers and Pre-school 1-5 years 11-12 hours 11.4-13.5 hours School Age 6-10 years >/=10 hours 9.9-11 hours Teenagers 12-18 8.5-10 hours 8.1-9.6 hours
Table 1. Estimated Normative Values for Total Sleep Time Form Birth to 18 years. * https://www.nhlbi.nih.gov/health/health-topics/topics/sdd/howmuch
420 430 440 450 460 470 480 490 Sun Mon Tue Wed Thu Fri Sat DAY Total Sleep Time (min)
African American Children – Ages 6-18 (n=42)
Alfano C, et al. Sleep (2007) Abstract Supplement, 30: p. A96
Sleep Academic Award, Gerald Rosen
Process Sleep Process Clock
Sleep Academic Award, Gerald Rosen
Process S Sleep Homeostatic Process C Circadian
Reduced homeostatic drive 1st sleep 2nd sleep
Accidents by Time of Day
Sleep Academic Award, Mark Muhowald
What Mediates Sleep Propensity and Wakefulness
Bio-history of the sleep wake system Light Lifestyle choices Drugs/alcohol Vigilance Social/workplace
Sleep and Circadian Health Effects
expenditure
not nap during the day
never sleeps
asleep during the day but sleep 11 hours at night
terrible!
“Frequent and persistent difficulty initiating
sleep dissatisfaction…despite adequate sleep opportunity”
International Classification of Sleep Disorders, 3rd Edition., American Academy of Sleep Medicine, Darien, Illinois (2014), p. 23
– Adults – fatigue, decreased mood or irritability, general malaise, cognitive impairment, social and vocational impairment and poor quality of life – Children - poor school performance, impaired attention and behavioral disturbance
ability to sleep during preferred phase
– Establish Sleep as a priority (time limited) – Regular bed & wake times – Regulate napping – Eliminate or regulate caffeine habit – Eliminate stimulating behavior before bedtime – No electronic media use within a half hour of bedtime
– Quiet time & close time – Establish an early evening worry time
– Optimal sleep duration by age
6-8:10.5-11h; 9-11: 10-11h; 12-14 9.5-10.5h; 15-18: 8.5-10h.
– Optimal sleep schedule by age
6-8:7:30-8:30; 9-11: 8:00-9:30; 12-14 9:00-10:30; 15- 18: 10:00-11:30.
– Two process model of sleep – Regulation of napping – Sleep continuity
http://www.bbc.com/news/magazine-16964783
Stimulus Control
with frustration/activation
– Thoughtful planning – Analysis of cues (extrinsic – clock, bed, light) – Analysis of cues (intrinsic – Anxiety, rumination, faulty assumptions)
misperception)
Cognition
– Address sleep-related misconceptions, predictions, and myths – Tools to decrease cognitive arousal
topping thoughts)
not true then? Turn it around. Who would you be without that thought)
– PASS (Positive Affect Stimulation Sustainment) or Savouring (McMack, 2015; Harvey,
AG
Sleep Restriction –Limit TST to weekly average –Setting a fixed sleep window
Relaxation Therapy
– Tools to decrease physiological and cognitive activation
–Active and passive
–Investigate different channels
(yoga, Tai Chi, Karate, running, meditation prayer)
A shift of the sleep phase to a later period that conflicts with academic and work schedules & social norms
affects 7% of adolescents
“make up” for weekday sleep loss
lag” Adjustment takes 1 day/time zone
crossed Effects persist up to 3 days Associated with daytime sleepiness, poor academic performance, depressed mood
Session1
9am WE
Mid-sleep time= TST/2 = bedtime ~5am Average TST = 8.9hrs Estimated DLMO – 11pm-12am
Circadian Rhythm Disorder, Delayed Sleep Phase Syndrome: Treatment
bedtime
sleep debt)
Danny Lewin, Ph.D. (Dlewin@CNMC.org) Children’s National Medical Center Department of Pulmonary and Sleep Medicine
within an hour of bedtime
Starsleep.nhlbi.nih.gov
Management of Sleep Problems (Jodi Mindell & Judith Owens)
Ferber