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

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

3 24h body clocks (circadian clocks) and sleep processes have captured the popular imagination

4 Sometimes not always helpful!

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

10 5 Mood 10pm 7am 28 Growth Hormone ng/ml 200 Melatonin pmol/l Core Body Temperature C Systolic Pressure mm Hg Cortisol µg/100ml 37.5 C C C Urine volume ml/min Alertness Sleep

11 Stroke Frequency Oxford Vascular Study (Peter M Rothwell )

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

Lifetime Activities Telephone/ Mail/Email 1% Sleep 36% Sport/Exercise 1% Socialising 3% Household work 8% Eating & Drinking 11%

13 Lifetime Activities Telephone/ Mail/ 1% Sleep 36% Sport/Exercise 1% Socialising 3% Household work 8% Eating & Drinking 11% Watching TV 11% General activities 19% Work & Work related 16% Data from - American Time Use Survey Summary

14 ~21.5 years asleep!

15 "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 ( )

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

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

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

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

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

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

22 Suprachiasmatic nuclei (SCN)

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

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

25 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.

factor in the crash, and the Exxon Shipping Company was

International Nuclear Safety Group determined that human error

Air India Express Accident investigators said that the pilot

26 In USA 100,000 crashes every year are related to sleepiness 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 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.

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

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

30 Appetite - + Leptin Ghrelin Adipose Tissue Sleep Disruption

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

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

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

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

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

36 Delayed Body Clock (Biology)

37 Evening Morning vs Evening Preference changes with age Chronotype (MSF sc, time around midnight) Male Morning Age Roenneberg et al., Curr Biol, 2004

00 is the same as making a 50 year old getting up

38 Evening Morning vs Evening Preference changes with age Chronotype (MSF sc, time around midnight) Male Female Making a teenager get up at is the same as making a 50 year old getting up at 05.00! 2 hour difference Morning Age Roenneberg et al., Curr Biol, 2004

39 Reduced Sleep (Sociology)

41 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.

42 Impact of a later school start time

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

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

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

46 Not getting enough sleep if. Opinion 22 April 2013 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..

So. Take control. Opinion 22 April 2013 Why teenagers really do need an extra hour in bed Bedroom must be dark and not too warm. Calm down prior to sleep.

47 So. Take control. Opinion 22 April 2013 Why teenagers really do need an extra hour in bed Bedroom must be dark and not too warm. 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

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

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

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

Emil Kraepelin (1856-1926) Noted in his 1883 textbook

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

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

53 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)

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

55 Activity/Rest (Sleep) Profile Sleep Onset Wake Days 1 Melatonin Peak 45

56 Unemployed 00 h Schizophrenia 1 Schizophrenia 2 Schizophrenia 3 midnight 00 h Schizophrenia 7 Schizophrenia 6 Schizophrenia 5 Schizophrenia 4 Wulff, K., Middleton, B., Dijk, D-J., Foster, R.G., Joyce, E. (2012) Sleep and circadian rhythm disruption in schizophrenia patients. British Journal of Psychiatry 200(4) 1-9.

57 Acetylcholine Noradrenaline Histamine Dopamine Serotonin Glutamate GABA Galanin Orexin SLEEP WAKE Eye Clock Sleep Pressure Social Timing

58 Do the networks in the brain that generate normal sleep and mental health overlap? Mental Illness Overlapping Brain Pathways & Mechanisms Sleep Disruption Wulff, K., Gatti, S., Wettstein, J.G. and Foster, R.G. (2010) Sleep and Circadian Rhythm Disruption in Psychiatric and Neurodegenerative Disease. Nature Reviews Neuroscience 11(8),

(hours) 00 12 00 12 00 High risk Time of

59 Sleep Disruption Observed in those at risk of Bipolar Low risk Time of Day (hours) High risk Time of Day (hours) Days of measurements

60 Partial consolidation of SCRD using CBT reduces symptoms in schizophrenia * Mean Score Baseline Post-Treatment Follow-up Mean Score Baseline Post-Treatment Follow-up Insomnia Delusion

61 Do the networks in the brain that generate normal sleep and mental health overlap? Mental Illness Overlapping Brain Pathways & Mechanisms Sleep Disruption THERAPUTICS MECHANISMS BIOMARKER Wulff, K., Gatti, S., Wettstein, J.G. and Foster, R.G. (2010) Sleep and Circadian Rhythm Disruption in Psychiatric and Neurodegenerative Disease. Nature Reviews Neuroscience 11(8),

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

Light, body clocks and sleep - SE13

Light, body clocks and sleep - SE13 Friday 4th January 2013 10:15-11:00 Location: Palmer, 109 Russell G. Foster FRS Professor of Circadian Neuroscience Head, Nuffield Laboratory of Ophthalmology Fellow,